Thoracic Outlet Syndrome

Thoracic outlet syndrome is one of a group of disorders that produce symptoms of pain and numbness in the neck, shoulders, arms and hands. It affects mainly young to middle-aged adults, women more than men. Frequent signs may include the following:

• Pain, numbness and tingling in the neck, shoulders, arms, and hands.
• Weakness in the arms and hands.
• Absent pulse in the wrist when raising the arm and turning the head toward the opposite shoulder.

The pain is often described as aching or throbbing. It is frequently aggravated by activity, especially that involving arm elevation above the shoulders. It may last for hours after the physical activity has ceased. The causes of this disorder are numerous and complex. The nerves and blood vessels that supply the shoulder, arms and hands start in the neck and pass as a bundle near the top of the ribs and collar bone. Pressure on this nerve and blood vessel bundle creates symptoms. Pressure may also be caused by an extra rib in the lower neck, muscle weakness in the shoulder, or an injury from overextending the arm and shoulder.

Upon seeing your doctor, a careful examination of the neck, shoulder, and entire upper extremity as well as a complete neurological exam will be performed. A chest x-ray and often a vascular exam that records blood pressure in both arms will be done.

Treatment usually involves physical therapy and exercises unless there is an obvious bony abnormality. Although surgery is sometimes indicated to relieve the pressure on nerves and blood vessels, conservative measures are often successful without surgery.

Physical therapy begins with an explanation of the muscle groups, teaches safe positions and strengthens muscle groups. Exercise should be tried for a minimum of six weeks. Ultrasound and head treatments may be recommended in addition to anti-inflammatory drugs or muscle relaxants. A small number of patients may not benefit from these treatments or may not tolerate them because their symptoms are aggravated by the exercises.

If surgery is recommended by your surgeon, you can PLAN TO BE ADMITTED TO THE HOSPITAL THE MORNING OF SURGERY. Patients are usually in the hospital for one day following the surgical procedure. Post-operative pain will be treated with pain medication. A small amount of swelling after surgery is normal and can be relieved somewhat by elevation. Following surgery there will be an area under your arm that will have some numbness and sensitivity sometimes lasting for up to 6 months.

You will return to the office one week after your surgery at which time your dressing will be removed. Basic exercises may be started the say you go home. You will receive instructions on exercises from the nurse in the hospital before you are discharged.

At your one-month visit your surgeon will increase the exercises. Patients can usually return to work within 8-12 weeks. Please discuss this with your surgeon.

Please remember that pain medication can sometimes cause an upset stomach and often can cause constipation. Therefore, drink plenty of fluids and eat fresh fruits and vegetables daily.