Signs of Thoracic outlet syndrome

Description

The thoracic outlet is the region where neurovascular structures exit the chest, and it is composed of the first rib, the subclavian artery and vein, the brachial plexus and the upper part of the lung. Any enlargement or movement in these structures can cause compression of the nerve or blood vessels. Occasionally patients will have an extra rib that causes the syndrome. This compression causes the symptoms experienced in the neck and arm. It occurs more often in women between ages 35 and 55.

Symptoms

Pain, numbness, and tingling in the last three fingers and inner forearm. Pain and tingling in the neck and shoulders. Bluish discoloration of the hand, weakness of the muscles in the hand. Symptoms can become worse with lifting the arm above the head.

Tests

A history and physical exam will be performed. Tests to establish the diagnosis may include: X-ray (to reveal an extra rib), MRI, nerve conduction velocity study, and electromyography (EMG).

Standard Workup

X-Ray
MRI

Treatment

Therapy depends on the severity of the illness, and the specific cause of the disorder. Treatment may include: physical therapy, behavioral modifications, losing weight, nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn), and/or pain medications such as acetaminophen (Tylenol). Surgery may be necessary for persistent or severe symptoms.