Thoracic Outlet Syndrome

Thoracic Outlet Syndrome Treatment in Hyderabad, India

Treat Thoracic outlet syndrome at CARE Hospitals in India 

Compression of blood vessels or nerves in the collarbone and the first rib in the thoracic outlet causes a group of pains in the neck and numbness in the fingers. This disorder is called TOS or thoracic outlet syndrome. 

The causes can vary; it can be due to car accidents, repetitive injuries, sports or jobs related physical activities, other anatomical defects, and even pregnancy. Sometimes a diagnosis can't validate a cause behind thoracic outlet syndrome. 

The treatment plan for this is the same; regardless of any cause- physical therapy and pain relief measure, only the selected cases opt for surgery. 

Types of Thoracic Outlet Syndrome (TOS) 

Thoracic Outlet Syndrome (TOS) encompasses different types, each associated with specific anatomical structures involved. The main types of TOS are:

• Neurogenic Thoracic Outlet Syndrome (NTOS): This is the most common type of TOS, accounting for the majority of cases. It involves compression or irritation of the brachial plexus, a network of nerves that originate in the neck and extend into the arm. NTOS can result from compression between the scalene muscles, the first rib, and the clavicle.
• Vascular Thoracic Outlet Syndrome (VTOS):
  • VTOS involves compression or obstruction of the blood vessels (arteries or veins) in the thoracic outlet region. This compression can occur between the first rib and the clavicle or other structures, leading to symptoms such as swelling, pain, or discoloration of the arm. Subtypes of VTOS include arterial and venous TOS.
  • Arterial TOS: Compression of the subclavian artery can lead to decreased blood flow to the arm, potentially causing symptoms like coldness, numbness, or pain.
  • Venous TOS: Compression of the subclavian vein may result in blood clot formation (thrombosis) and swelling in the arm. This form is often associated with effort-related symptoms, such as swelling during activities.
• Non-specific or Disputed Thoracic Outlet Syndrome: This category may include cases where symptoms are present, but the specific anatomical cause is unclear or debated. It can involve a combination of neurogenic and vascular components.

Symptoms of Thoracic Outlet Syndrome (TOS)

The symptoms of thoracic outlet syndrome can depend on three major causes. The causes are the types of thoracic outlet syndrome that have different symptoms.

• Neurogenic (neurologic) thoracic outlet syndrome is a common type of thoracic outlet syndrome that occurs due to compression of the brachial plexus (network of nerves from the spinal cord to shoulder, arm and hand).

• Venous thoracic outlet syndrome- the compression of the clavicle can result in blood clots and cause venous thoracic outlet syndrome.

• Arterial thoracic outlet syndrome- the last type of thoracic outlet syndrome occurs due to the compression of arteries inside the collarbone. This results in a bulging artery called an aneurysm.

One may also face multiple thoracic outlet syndrome, and hence the symptoms can vary from different types. The common symptoms and signs include- 

• Numbness in your arm or fingers

• tingling in your arm or fingers

• Pain or aches in the neck, shoulder, arm, or hand

• Weakening grip

For the venous thoracic outlet syndrome-

• Discolouration of colour blue of your hand

• Arm pain

• Arm swelling

• Blood clot in veins in the upper body

• Arm fatigue with activity

• Paleness in one or more fingers or the whole hand

• Abnormal colour in one or more fingers or the whole hand

• Throbbing lump of the collarbone 

For arterial thoracic outlet syndrome- 

• Cold fingers

• Cold hands

• Cold arms

• Hand and arm pain

• Lack of colour or a bluish colour in one or more of your fingers or the hand

• Weak or no pulse in the arm 

Causes of Thoracic Outlet Syndrome (TOS) 

• Congenital: These involve inherent variations in anatomical structures present from birth. Examples include conditions like a cervical rib, an additional rib located near or fused to the first rib. Abnormalities in ribs, neck muscles, or nearby ligaments may also contribute, potentially exerting pressure on nerves or blood vessels within the thoracic outlet.
• Traumatic: This category encompasses sudden injuries affecting the neck and upper chest area. Common instances include injuries resulting from car accidents, such as whiplash, which can impact the structures in the thoracic outlet.
• Functional: These causes result from repetitive actions that irritate or injure the structures in the thoracic outlet. Athletes, particularly baseball players and swimmers, may experience TOS due to vigorous arm movements. Similarly, professions requiring repeated overhead lifting may contribute to the development of TOS through chronic overuse.

Risks of Thoracic Outlet Syndrome (TOS)

Many factors can increase the risk of thoracic outlet syndrome. The following are-

• Sex- More females are affected by thoracic outlet syndrome than men. The ratio is 3:1.

• The thoracic outlet syndrome can occur at any age but is commonly seen in adults aged 20 to 50. 

Diagnosis of Thoracic Outlet Syndrome (TOS)

• The signs and symptoms can vary widely among people with thoracic outlet syndrome. It can be due to other health conditions and age-related factors.

• All the diagnosis starts with preliminary examinations, are the physical tests. These tests consist of diagnostics and examinations to check the organ functioning of the body. The blood pressure, pulse rate, oxygen level, and other factors are checked.

• Doctors at CARE Hospitals will also look into the patient's medical history. A medical history along with genetics is checked to validate the outcome. Additional imaging and testing are also conducted.

• Physical examination- these are done to look for the external examinations of the thoracic outlet syndrome like depression in the shoulder, a bony collar bone abnormality, swelling or paleness in the arm or abnormal pulse. The range of motion is checked to know how affected your area is, along with the other signs and symptoms. These movements will help the doctor to diagnose the type of thoracic outlet syndrome.

• Medical history- the occupation, daily life activities (doctors can check the gym activity and the type of workouts).

Imaging Tests of Thoracic Outlet Syndrome (TOS)

After the preliminary examination, imaging tests are conducted by the doctor to know the status of the thoracic outlet syndrome-

• Ultrasound- the test is conducted with the help of sound waves that are employed to image the internals of the body. It can help diagnose the thoracic outlet syndrome, commonly detecting the venous thoracic outlet syndrome.

• X-ray- Cervical ribs can be detected using the X-ray machine and rule out the conditions that are causing the symptoms.

• Computerised tomography or the CT scan- cross-sectional X-ray images of the body are obtained with a CT scan, and one can see and study the blood vessels. It can also use a dye to know the status of the vessels and know the cause and location of the compression.

• Magnetic resonance imaging or MRI- The magnetic waves and radio waves are used to create the internal organs of the body to determine the location and cause of the blood vessels. The congenital abnormalities like the fibrous band can be analysed in this along with the head, shoulders, and neck positions.

• Arteriography and venography- arteries and veins are studied with arteriography and venography with the help of a catheter (thin tube) inserted inside the body's small incision to study the blood vessels. X-rays are taken out for further studies.

• Electromyography- electrodes are inserted in various muscles to evaluate the electrical activity of the muscles to determine nerve damage. 

Treatment of Thoracic Outlet Syndrome (TOS)

When the condition is diagnosed early, it can be treated with the help of a conservative approach. The main treatments are as follows-

• Physical Therapy- the condition of neurogenic thoracic outlet syndrome can be treated with physical therapy. To open the thoracic outlet, shoulder workouts involving stretches are employed to open the shoulder muscles. It can improve the range of motion and posture. It can take the pressure off the blood vessels and nerves.

• Medications- Pain relievers, anti-inflammatory, and other muscle relaxants are employed or prescribed to decrease the pains and inflammations. It can help in relaxing the muscles and ease out the movements. The blood thinners may also be employed if any clots are detected inside. 

• Clot-dissolving medications- Clot dissolving medications like thrombolytics or preventing medicines like anticoagulants are given by the doctors in conditions like venous or arterial thoracic outlet syndrome.

Surgery of Thoracic Outlet Syndrome (TOS)

•  If a patient has progressive neurological syndrome or experiences worsening of symptoms with no effect from conservative treatments, doctors at CARE Hospitals opt for surgical methods.

• Thoracic outlet syndrome surgery is done for the chest with the side-effects of injuries to the brachial plexus.

• The decompression can remove the muscles and portion of the first rib to treat compressions and repair the blood vessels. 

• The clot removal and repairing are also done in the venous or arterial thoracic outlet syndrome. It can decompress the arteries and can also replace the damaged artery with another graft.

Complications of Thoracic Outlet Syndrome (TOS) 

Thoracic Outlet Syndrome (TOS) can lead to various complications, including:

• Nerve Compression Symptoms: Persistent compression of nerves in the thoracic outlet can result in symptoms such as pain, tingling, and weakness in the arms and hands. In severe cases, it can lead to muscle wasting (atrophy) and difficulty performing fine motor tasks.
• Vascular Complications: Vascular TOS, involving compression of blood vessels, can lead to complications such as blood clots, swelling, and discoloration in the affected arm. In severe cases, it may result in reduced blood flow, causing damage to tissues and potentially leading to conditions like deep vein thrombosis (DVT) or arterial thrombosis.
• Chronic Pain and Discomfort: Individuals with TOS may experience persistent pain and discomfort in the neck, shoulders, and arms. This chronic pain can significantly impact daily activities and quality of life.
• Impaired Functionality: Weakness and reduced range of motion in the affected arm can lead to functional limitations, affecting the ability to perform routine tasks and participate in physical activities.
• Psychological Impact: Living with chronic pain and physical limitations can have psychological consequences, including stress, anxiety, and depression. The impact of TOS on daily life and well-being can contribute to emotional distress.

Why Choose CARE Hospitals in India? 

At CARE Hospitals in India, we try to provide the best world-class services that benefit the entire community. We aim to treat each person as an individual, not a patient, an ailment, or an appointment - it's central to all we do. One passion drives our commitment to education, research, and the people we serve: linking our patients, team members, and communities to their health.