What is Thoracic Outlet Syndrome?

Question

What are the symptoms and what tests are done to diagnosis? Who can diagnosis this syndrome? I am asking this in regard to bilateral carpal tunnel syndrome.

Answer 1

First of all a syndrome is defined as a group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition.
The neurovascular bundle which can suffer compression consists of the brachial plexus plus the C8 and Tl nerve roots and the subclavian artery and vein.
The brachial plexus is the network of motor and sensory nerves which innervate the arm, the hand, and the region of the shoulder girdle.
The vascular component of the bundle, the subclavian artery and vein transport blood to and from the arm, the hand, the shoulder girdle and the regions of the neck and head.
The bony, ligamentous, and muscular obstacles all define the cervicoaxillary canal or the thoracic outlet and its course from the base of the neck to the axilla or arm pit

Answer 2

The thoracic outlet is an opening on the upper end of thoracic bony cage. This outlet lets blood vessels, nerves and some other structures to move from the chest to the arms and the neck (and the head).

Sometimes the structures coming out from the outlet can get compressed and give rise to a set of symptoms and signs (syndrome) known as the thoracic outlet syndrome.

Answer 3

From the link below: Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). For the most part, these disorders have very little in common except the site of occurrence. The disorders are complex, somewhat confusing, and poorly defined, each with various signs and symptoms of the upper limb.

Answer 4

horacic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). For the most part, these disorders have very little in common except the site of occurrence. The disorders are complex, somewhat confusing, and poorly defined, each with various signs and symptoms of the upper limb.

Answer 5

A syndrome is a combination of signs and symptoms that characterizes an abnormal condition. A physician must review all of these signs and symptoms in order to make a diagnosis. That's certainly the case with thoracic outlet syndrome, or TOS.

TOS gets its name from the space (the thoracic outlet) between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. If the shoulder muscles in your chest are not strong enough to hold the collarbone in place, it can slip down and forward, putting pressure on the nerves and blood vessels that lie under it. Symptoms vary, depending on which structures (nerves or blood vessels) are being compressed. Pressure on the blood vessels can reduce the flow of blood to your arms and hands, making them feel cool and tire easily. Pressure on the nerves can leave you with a vague, aching pain in your neck, shoulder, arm or hand. Overhead activities are particularly difficult.

TOS can result from injury, disease, or a congenital abnormality. Poor posture and obesity can obesity can aggravate the condition, which is more common in women than in men. Psychological changes are often seen in patients with thoracic outlet syndrome. It is not clear whether these precede the onset of the syndrome or are the result of dealing with the pain and frustration of diagnosing and treating this condition.

Diagnosis

When you visit your doctor, he or she will ask you about the history of your symptoms, give you a physical examination and try to reproduce your symptoms through a series of tests to diagnose TOS. There may be a depression in the shoulder, or a swelling or discoloration in the arm. Range of motion may also be limited. X-rays may be recommended; an MRI (magnetic resonance imaging), nerve conduction tests, or ultrasound may be used to rule out other possible causes for your symptoms. Your doctor may order special blood circulation tests and elecrodiagnostic tests to aid in making the diagnosis of TOS.

Treatment

The treatment for TOS is conservative, and does not usually involve surgery.


Physical therapy can help strengthen the muscles surrounding the shoulder so that they are better able to support the collarbone.

Postural exercises can help you stand and sit straighter, which lessens the pressure on the nerves and blood vessels.

Nonsteroidal anti-inflammatory drugs, like aspirin or ibuprofen, can ease the pain.

If you are overweight, your physician may recommend that you go on a diet.

You may need to change your workstation and avoid strenuous activities.

In rare cases, surgery may be recommended if conservative treatment fails. The surgery involves dividing a muscle in the neck and removing a portion of the first rib.

Avoiding TOS

If you have symptoms of TOS, avoid carrying heavy bags over your shoulder because this depresses the collarbone and increases pressure on the thoracic outlet. You could also do some simple exercises to keep your shoulder muscles strong. Here are four that you can try; do 10 repetitions of each exercise twice daily.

1. Corner Stretch: Stand in a corner (about one foot away from the corner) with your hands at shoulder height, one on each wall. Lean into the corner until you feel a gentle stretch across your chest. Hold for 5 seconds.

2. Neck Stretch: Put your left hand on your head, and your right hand behind your back. Pull your head toward your left shoulder until you feel a gentle stretch on the right side of your neck. Hold for 5 seconds. Switch hand positions and repeat the exercise in the opposite direction.

3. Shoulder Rolls: Shrug your shoulders up, back, and then down in a circular motion.

4. Neck Retraction: Pull your head straight back, keeping your jaw level. Hold for 5 seconds.

As with any exercise program, if you start to hurt-stop!

Answer 6

http://www.ninds.nih.gov/disorders/thoracic/thoracic.htm

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome

Answer 7

http://www.nismat.org/ptcor/thoracic_outlet/

I have this syndrome. You can be diagnosed by a neurologist, which is what I recommend.
Treatments and limitations vary, but you can do exercizes to improve the symptoms, which is what I do.