The thoracic outlet is the space between your collarbone (clavicle) and your first rib, in the front of the shoulder. 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. This causes a variety of symptoms which together are known as "thoracic outlet syndrome".
The thoracic outlet is the space between your collarbone and first rib.
This condition may result from injury, disease, or a congenital problem, such as an abnormal first rib. It is more common in women than in men, and poor posture and obesity can aggravate the condition. Psychological changes are often seen in patients with thoracic outlet syndrome. It is not clear whether these changes are a cause or result of the syndrome.
Symptoms of thoracic outlet syndrome may vary, depending on which nerves or blood vessels are compressed. Symptoms from nerve compression are much more common than symptoms from blood vessel compression.
Diagnosis of thoracic outlet syndrome is difficult and can be more complicated than diagnosis of some other more common shoulder conditions because there may be many symptoms to explain. Your doctor's evaluation will include an extensive medical history, physical examination, and diagnostic testing.
Dr van den Berg will ask you about the history of your symptoms, perform a thorough physical examination, and try to reproduce your symptoms by examining your arm and hand in several positions.
A test doctors often use to help them identify thoracic outlet syndrome is the elevated arm stress test. Your doctor will have you raise your arms over your head, then open and close your fists for approximately 3 minutes. If this reproduces your symptoms, it is likely that you have thoracic outlet syndrome.
To better see and evaluate the bones, muscles, tendons, and blood vessels, your doctor may order imaging tests. These may include x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound.
In addition, your doctor may order special blood circulation tests and nerve conduction tests to help diagnose thoracic outlet syndrome.
Treatment for thoracic outlet syndrome usually does not include surgery.
If nonsurgical treatment does not relieve thoracic outlet syndrome symptoms, your orthopaedic surgeon may recommend surgery. Surgery for thoracic outlet syndrome may involve removing a portion of an abnormal first rib, releasing a muscle that joins the neck and chest, or sometimes both.
If you have symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder because this depresses the collarbone and increases pressure on the important structures in the thoracic outlet.
If you have thoracic outlet syndrome you should also do some simple exercises to keep your shoulder muscles strong. Here are four that you can try—10 repetitions of each exercise should be done twice daily:
As with all exercise programs, if any of these movements cause pain, stop immediately.