Finding Relief for Thoracic Outlet Syndrome

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Charles West, M.D., Vascular Surgery

Thoracic outlet syndrome is a broad term for multiple conditions that occur in the narrow space between the collarbone and the first rib. Understanding the name of the group of disorders is the first step to uncovering the intricacies of caring for people with this problem, says Charles West, M.D, a vascular surgeon at Texas Health Vascular Surgical Specialists, a Texas Health Physicians Group practice in Fort Worth.

“We call it TOS because it’s a way to regionalize the disease,” says West, who has two decades of experience in the field. “You can think of it as these conditions all live in the same neighborhood but are very different.”

Ninety percent of what West treats is known as neurogenic TOS, which he says is caused by the compression of the brachial plexus, a network of nerves that extend from the spine and control movements in the shoulders, arms and hands. When these nerves are compressed, it can cause pain in parts of the neck, shoulder, arm or hand; numbness in the forearm and fingers; and weakness of the hand.

Venous TOS and arterial TOS are less common types of the condition, according to the National Institute of Neurological Disorders and Stroke (NINDS). Venous TOS affects the veins, and symptoms are a weak or absent pulse in the affected arm, which also may appear cooler and paler than the unaffected arm. Arterial TOS affects the arteries, causing symptoms such as a change in color and cold sensitivity in the hands and fingers; swelling; and poor blood circulation in the arms, hands and fingers.

West stresses that TOS creates different symptoms in different people. Some may have limited range of motion when trying to lift their arms above their head. Others may have pain, weakness or fatigue when moving the shoulders and arms.


Are You at Risk?

According to the NINDS, thoracic outlet syndrome often affects people ages 20 to 50, with a higher incidence seen in women. The cause of TOS isn’t always known, but it may result from physical trauma from accidents, tumors that press on nerves, poor posture that causes nerve compression and pregnancy. Some people may have an “inherent anatomical disadvantage” due to being born with an extra rib or having a naturally occurring smaller space in the thoracic outlet, West says.

Another at-risk group is what West refers to as “overhead athletes,” who repetitively lift their arms and shoulders during sports. This can include swimmers, baseball pitchers and rodeo ropers.

One problem with diagnosing TOS is there is no definitive test, West explains. The Society of Vascular Surgery says an X-ray, MRI or electromyography can be performed to examine the thoracic outlet area, but it’s often up to the doctor to determine if a patient has TOS.

“The best test we have to determine if someone has TOS is medical history and a physical examination,” West says, adding that the assessment often includes observing when pain is felt with a change in the position of the neck, arms and shoulders.

According to West, when TOS is suspected, the first course of treatment is often physical therapy. This is done to try to release the entrapment, increase flexibility and strengthen the chest muscles. There’s also hope that physical therapy will improve posture and relieve compression by increasing the space the nerve passes through.

Next steps depend on the source of the condition and often include non-steroidal anti-inflammatory drugs to manage pain or other medicines to break up or prevent blood clots.

If these treatments don’t relieve the problem, a doctor may recommend thoracic outlet decompression surgery to release or remove the structures causing compression. West says most patients who are treated surgically have a good to excellent outcome.

After studying and working with experts in the specialty, West knows the importance of providing individualized care for his patients.

“It’s essential to have a doctor who has the judgment and timing to know the course of treatment,” he says. “Often that expertise is what makes the biggest difference.”

If you suspect you have symptoms of TOS, find a heart and vascular specialist today.

Texas Health Physicians Group providers are employed by Texas Health Physicians Group and are not employees or agents of Texas Health Resources hospitals.

Doctors on the medical staff s practice independently and are not employees or agents of Texas Health hospitals or Texas Health Resources.


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