Thoracic outlet syndrome (TOS) occurs when the nerves or blood vessels in the area between your collarbone and ribcage (the thoracic outlet) become compressed. The syndrome occurs most frequently in people whose occupations or hobbies require use of the upper extremities against force, such as construction workers who use jackhammers or weightlifters, but it can develop from other causes as well.
Thoracic outlet causes can vary, and may include:
anatomical abnormalities, including being born with an extra rib or having very tight ligaments
traumatic injury, such as a car accident or serious fall
poor posture that causes the shoulders to “droop” forward
repetitive motion, such as typing for long hours, competitive swimming or working on an assembly line
obesity, which causes chronic increased stress on joints and other tissues
pregnancy, which can cause joints to become loose and also increase pressure on joints
prolonged periods of pressure on the joints, such as carrying a backpack or heavy messenger bag day after day
Thoracic outlet syndrome may cause different symptoms depending on whether nerves or blood vessels – or both – are involved. The most common symptoms include:
pain and numbness in the neck, shoulder, arm or hand
discoloration in the arm and hand
cool temperature in the arm and hand
weakness in the arm or neck
tingling sensations in the hands and fingers
weakened pulse in the arm
Treatment of TOS begins conservatively with medications to reduce inflammation, relax muscles or dissolve clots, physical therapy and exercises to improve posture. When these approaches fail to provide relief, a type of surgery called thoracic outlet decompression may be needed.
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