How to deal with thoracic outlet syndrome?
Thoracic outlet syndrome 1 Diagnosis. Diagnosing thoracic outlet syndrome can be difficult because the symptoms and their severity can vary greatly among people with the disorder. 2 Treatment. ... 3 Lifestyle and home remedies. ... 4 Coping and support. ... 5 Preparing for your appointment. ...
How are clot dissolving medications used to treat thoracic outlet syndrome?
If you have venous or arterial thoracic outlet syndrome and have blood clots, your doctor may administer clot-dissolving medications (thrombolytics) into your veins or arteries to dissolve blood clots.
What tests are used to diagnose thoracic outlet syndrome?
Ultrasound. An ultrasound uses sound waves to create images of your body. Doctors may use this test to see if you have vascular thoracic outlet syndrome or other vascular problems. Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your body.
What are the risks of thoracic outlet surgery?
Thoracic outlet syndrome surgery has risks of complications, such as injury to the brachial plexus. Also, surgery may not relieve your symptoms, and symptoms may recur. Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be performed using several different approaches, including: Transaxillary approach.
What is the best treatment for thoracic outlet syndrome?
How is thoracic outlet syndrome treated?Physical therapy is typically the first treatment.Botulinum toxin injections are sometimes effective when physical therapy doesn't completely relieve symptoms.If symptoms persist after physical therapy and injections, surgery may be recommended.
Which of the following can be used to treat thoracic outlet syndrome?
Physical therapy: The most common initial treatment for neurogenic thoracic outlet syndrome is physical therapy. Physical therapy increases the range of motion of the neck and shoulders, strengthens muscles and promotes better posture.
What can you not do with thoracic outlet syndrome?
If you're at risk for thoracic outlet compression, avoid repetitive movements and lifting heavy objects. If you're overweight, losing weight may help you prevent or relieve symptoms of thoracic outlet syndrome.
What is the procedure for thoracic outlet syndrome?
Surgery to treat thoracic outlet syndrome, called thoracic outlet decompression, may be performed using several different approaches. These approaches involve removing a muscle and a portion of the first rib to relieve compression. You may also need surgery to repair compressed blood vessels.
Does massage help thoracic outlet syndrome?
Massage therapy is an excellent addition to most treatment plans for Thoracic Outlet Syndrome. The compression caused by the scalenes can be decreased by relieving those muscles of tension through direct massage.
Can Chiropractors treat thoracic outlet syndrome?
Treatment for Thoracic Outlet Syndrome Once diagnosed, chiropractors generally treat TOS through a series of interventions, which may include thoracic (upper back) spinal adjustments, stretching, manual trigger point therapy and other myofascial release techniques targeting the affected muscles.
How does Botox help thoracic outlet syndrome?
Christo says the Botox works to temporarily relieve the pain of TOS in many patients because its paralyzing function decreases the tension and spasms of the muscle, relieving pressure on the nerves as more room is made for them to pass through the thoracic outlet.
How are cervical ribs treated?
Compression of the brachial plexus nerves is most common. This can cause pain and pins and needles in your arm on the affected side. Treatment can include painkillers, physiotherapy and sometimes surgery to relieve the compression caused by, for example, a cervical rib.
Which type of thoracic outlet syndrome is the most common?
The most common type of the condition, neurogenic thoracic outlet syndrome, is caused by the compression of the brachial plexus, a network of nerves that extend from the spine through the neck and into the arm.
Does vascular TOS require surgery?
Only 20 to 30 percent of patients with TOS need surgical treatment, so evaluation includes careful consideration of whether surgery will benefit the patient. Surgery primarily involves resection of the rib(s) and associated scalene muscles and release of scar tissue surrounding the neurovascular bundle.
When is surgery needed for TOS?
TOS surgery If your symptoms are too advanced and nonsurgical treatments don't help—or if you have venous or arterial TOS, which have a higher risk of complications—your provider may recommend surgery. Different surgical procedures are used to treat different types of TOS.
How do you perform Adson's test?
0:431:52Adson Test | Thoracic Outlet Syndrome - YouTubeYouTubeStart of suggested clipEnd of suggested clipSo let's get to it to do the Adson test bring your pace and shoulder into external rotation slightMoreSo let's get to it to do the Adson test bring your pace and shoulder into external rotation slight abduction and a little bit of extension. And try to palpate his radial pulse.
What are the different types of thoracic outlet syndrome?
There are 3 main types of thoracic outlet syndrome: neurogenic, vascular and arterial TOS. ( 3) Each type of TOS causes somewhat unique symptoms, although there is lots of overlap between the different types. Neurogenic TOS is the most common, followed by venous, and then arterial. Up to 85–95 percent of all patients with thoracic outlet syndrome ...
What does research suggest about thoracic outlet syndrome prognosis?
What does research suggest about thoracic outlet syndrome prognosis? Most people with TOS will find relief from symptoms if they follow an exercise and physical therapy program that addresses compression of their nerves and arteries. However, some people with more severe cases of TOS, especially vascular and neurogenic TOS, may need to use medications or undergo surgery to recover.
What is a TOS?
Thoracic Outlet Syndrome (TOS) is an “umbrella term” that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest, shoulders and arms. Technically, thoracic outlet syndrome is brought about by abnormal compression of the thoracic outlet ...
What is a Venous TOS?
Venous TOS is characterized by subclavian vein/artery compression in the space between the clavicle and first rib. This type is linked to thrombosis, or formation of a blood clot inside of a blood vessel in the subclavian vein.
How to heal from TOS?
Exercise is beneficial in numerous ways, but overtraining can contribute to TOS — especially if you exercise with poor form and don’t leave enough time between workouts for your muscles and joint to heal. Take breaks from repetitive exercises or movements that are contributing to your symptoms. Give yourself two days between tough workouts to properly recover. One effective way to do this is to focus on different muscle groups each workout so that you rotate body parts.
How to strengthen your chest and shoulders?
Always perform TOS exercises slowly and carefully so you don’t strain yourself and cause more pain. The goal is to perform upper body and shoulder exercises to help strengthen your chest and to stretch tight areas to the point where a stretch is felt intensely but that you are not feeling pain.
What are the risk factors for TOS?
TOS risk factors include: Being a woman, since women are affected more often than men. Being between the ages of 20 and 50 years of age, which is when symptoms usually start. Living a sedentary lifestyle, with too little physical activity.
New Treatment Option for Thoracic Outlet Syndrome
If you’ve had symptoms like numbness or tingling in your hands or arm, aches or pain in your shoulder or neck, a weakening grip, or the muscles in your hand shrinking, you may have been told you have thoracic outlet syndrome.
What Is the Thoracic Outlet?
The thoracic outlet is an area around the collar bone where the nerves that come from your neck meet up with the blood vessels from your heart and together supply the entire upper extremity (shoulder and arm).
What is Thoracic Outlet Syndrome (TOS)?
TOS symptoms are positional intermittent compression of the brachial plexus and/or subclavian blood vessels. There are 3 areas that can cause the compression (2). 1. Scalene triangle – Muscle spasms or chronically tight scalene muscles can compress the nerve plexus as the nerves travel through them. 2.
Is TOS Serious?
Like most syndromes, there is a variety from very mild cases to life-threatening. TOS is a group of symptoms in the chest, neck, shoulder, and arms and can be broken into 3 different types:
Common Symptoms of Thoracic Outlet Syndrome
Arm pain at night can be miserable. The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common. What are the causes? When should I worry about it? What are the treatment options for arm pain at night? The neck is composed of 7 boney building blocks numbered 1- 7.
How Do You Diagnose TOS?
Simply listening to a patient’s history and completing a physical examination is all that is needed to diagnose TOS. But more involved imaging such as X-rays, diagnostic ultrasound, MRIs, EMG (nerve conduction test) are used to rule out the underlying issue (2).
How Long does It Take to Recover from TOS?
Recovery depends on the severity of the syndrome and response to treatment. Thoracic Outlet Syndrome can resolve in a matter of weeks to months or can become chronic and last many years before getting proper treatment.
What are my treatment options for TOS?
The types of TOS include neurogenic TOS , venous TOS and arterial TOS. Let’s look at the treatment options for the three sub-types:
Neurogenic TOS
If you are at risk of developing TOS (because of the nature of your job or from sport), avoid repeated movements and lifting heavy weights. Losing weight is important to prevent or relieve symptoms of TOS.
Venous TOS
Any young and middle-aged patient with upper limb deep vein thrombosis (DVT) should be investigated for the possibility of venous TOS until proven otherwise. Patient with upper limb DVT should be considered for thrombolysis (clot-busting) as long there are not contra-indicated.
Arterial TOS
If arterial TOS is diagnosed before any complication e.g. blood clot blocking the blood flow, the patient should start on oral anticoagulation (blood thinners tablets) to prevent any blood clot.
How to treat thoracic outlet syndrome?
The vast majority of cases of Thoracic Outlet Syndrome (TOS) can be treated with a non-surgical approach. If you have pain and numbness in the neck, shoulder, and arm, and are diagnosed with thoracic outlet syndrome and then told that surgery is recommended it is a very good idea to explore non-surgical treatment options first. At Piedmont Physical Medicine and Rehabilitation, PA we offer many non-surgical treatment options and in the vast majority of cases they are successful. Restorative therapy, regenerative medicine techniques, and treatments that enhance blood flow are just a few of the choices available. Non-surgical treatment for thoracic outlet should be your first approach. When it comes to TOS these non-surgical treatments should be exhausted long before surgery is considered. Visit piedmontpmr.com to learn more about non-surgical alternatives for TOS in Greenville, Spartanburg, Anderson, and surrounding areas.
What is the best treatment for thoracic outlet?
Restorative therapy, regenerative medicine techniques, and treatments that enhance blood flow are just a few of the choices available. Non-surgical treatment for thoracic outlet should be your first approach. When it comes to TOS these non-surgical treatments should be exhausted long before surgery is considered.
Overview
- Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers.Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-rela…
- Pectoralis minor syndrome (PMS) is a condition causing pain, numbness and tingling in the hand and arm. It often coexists with thoracic outlet syndrome (TOS) but can also occur alone.
- Thoracic outlet syndrome (TOS) is a syndrome that can cause any combination of pain, weakness, numbness, tingling, sensation of coldness or, sometimes, a more general feeling of discomfort in portions of the upper body. It commonly affects in one or both of the upper limbs (arms) and/or the hands, armpits, upper back, neck and pectoral area of the chest.The term “thor…
Treatment
- Treatment of arterial thoracic outlet syndrome is surgical intervention. Treatment is required to treat or prevent acute thromboembolic events.Treatment of venous thoracic outlet syndrome depends primarily on the presence and extent of associated venous thrombosis and may include anticoagulation, thrombolysis, or surgical decompression.
- The diffuse and uncertain nature of this condition makes the application of randomised controlled trials (RCTs) very difficult. Because of this, the evidence base supporting the use of any treatment other than some specific surgical options is limited. 1. Conservative management is generally considered first-line (but see early surgical intervention, below). In cases where postural deviatio…
- Treatment There are essentially two ways to treat TOS, non-surgical, which is called conservative, or surgical. Neurogenic TOS is always initially treated with physical therapy. Many patients improve with this treatment and nothing further is needed. Neurogenic TOS can be treated surgically if conservative therapy fails and a patient is still having significant symptoms. Surger…
- As with most clinical disorders, a diagnosis of TOS should be based largely on the clinical symptoms a patient experiences and the physical exam by a doctor. Imaging tests – such as X-rays, MRIs, MRAs (magnetic resonance angiograms), MRVs (magnetic resonance venograms) – and electrodiagnostic tests may help your doctor make the diagnosis, but they should be used o…
Signs And Symptoms
- There are a number of types of thoracic outlet syndrome, including: 1. Neurogenic (neurological) thoracic outlet syndrome. This most common type of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. …
- The signs and symptoms of TOS include neck, shoulder, and arm pain, numbness or impaired circulation to the affected areas. Signs and symptoms of TOS help determine the type of disorder a patient has. Thoracic outlet syndrome disorders differ, depending on the part(s) of the body they affect. Thoracic outlet syndrome most commonly affects the nerves, but the condition can also …
- Neurogenic TOS presents with pain, weakness, numbness and tingling in the hand and arm. Additionally, neck pain and headache in the back of the head are common. Venous TOS, also known as Paget-Schroetter disease, presents with arm swelling, blue or dark discoloration, and a feeling of fullness or aching in the arm. Arterial TOS presents with coldness, numbness, tingling, …
Causes
- In general, the cause of thoracic outlet syndrome is compression of the nerves or blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include: 1. Anatomical defects. Inherited defects that are present at birth (congenital) may include an extra rib located above the first rib (cervical rib) or an abnormally tight fibrous band c…
- The disorders caused by TOS are not well understood. Yet, it is known that when the blood vessels and/or nerves in the tight passageway of the thoracic outlet are abnormally compressed, they become irritated and can cause TOS. Thoracic outlet syndrome can be a result of an extra first rib (cervical rib) or an old fracture of the clavicle (collarbone) that reduces the space for the …
- Neurogenic TOS is most often caused by neck trauma, whiplash injuries or repetitive stress injury at work being the most common events that bring on symptoms. The injury results in over-stretching neck muscles which heal by forming scar tissue in the muscle. This in turn puts pressure against the nerves to the arm which causes the symptoms. Venous TOS is often cause…
Diagnosis
- Due the it's variability, TOS can be difficult to tease out from other pathologies with similar presentations. A thorough history and evaluation must be done to determine if the patient’s symptoms are truly TOS. The following pathologies are common differential diagnosis for TOS : 1. Carpal tunnel syndrome 2. De Quervain’s tenosynovitis 3. Lateral epicondylitis 4. Medial epicond…
- 1. Acromioclavicular joint injury. 2. Brachial plexus injury. 3. Cervical disc injuries. 4. Cervical discogenic pain syndrome. 5. Cervical radiculopathy. 6. Clavicular injuries. 7. Elbow and forearm overuse injuries. 8. Shoulder impingement syndrome. 9. Thoracic disc injuries. 10. Thoracic discogenic pain syndrome.
- Neurogenic TOS is diagnosed by using provocative maneuvers to elicit (or provoke) symptoms. These maneuvers put the neck and arms in certain positions which put stress on the nerves to the arm to bring on the symptoms of pain, numbness and tingling in the hand, arm, and neck. Some of these maneuvers have been shown to be unreliable because positive responses are found in ma…
Complications
- If your symptoms haven't been treated early, you may experience progressive nerve damage, and you may need surgery. Doctors recommend surgery to treat thoracic outlet syndrome only when other treatments haven't been effective. Surgery has higher risks than do other treatments and may not always treat your symptoms.
- Generally prognosis is good, unless the condition is severe enough to merit surgery and spontaneous recovery will occur. However, sometimes complications occur: 1. Chronic pain. 2. Loss of function. 3. Depression. 4. Neurological complications. 5. Thrombosis, ischaemia or pseudoaneurysm. 6. Post-thrombotic syndrome of the lower limb following deep vein thrombosi…
Epidemiology
- Thoracic outlet syndrome affects people of all ages and gender. The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, volleyball, and other sports. Neurogenic TOS is the most common form of the disorder (95 percent of people with TOS have this form of the disorder) and generally affect…
- Because of a lack of a gold standard for diagnosis it is difficult to obtain meaningful epidemiological figures. Differences between disciplines exist with reports that surgeons diagnose the condition 100 times more frequently than neurologists. Irrespective of the overall incidence, it is estimated that over 90% of all TOS cases are neurogenic, whereas 3-5% are veno…
Clinical Presentation
- 1. Symptoms will depend on the type of TOS. In the neurogenic type, there may be painless wasting of the muscles of the hand, resulting in weakness (eg, difficulty in grasping a racket). Numbness or tingling of the upper limb may be reported. Symptoms are often vague and general and may affect the whole arm. There may also be a painful neck and headache. 2. If there is co…
Examination
- The following includes common examination findings seen with TOS that should be evaluated; however, this is not an all-inclusive list and examination should be individualized to the patient.
- A careful neurological and musculoskeletal examination is required. Neurological examination is discussed elsewhere - see separate Neurological Examination of the Upper Limbs article. Disease of the neck and arm must be excluded. Stress tests or provocative manoeuvres form the basis of examination. They have very low specificity, sensitivity and predictive value. 1. The most commo…
Prevention
- Thoracic outlet syndrome that goes untreated for years can cause permanent neurological damage, so it's important to have your symptoms evaluated and treated early, or take steps to prevent the disorder.If you're susceptible to thoracic outlet compression, avoid repetitive movements and lifting heavy objects. If you're overweight, you can prevent or relieve symptoms …
Diagnosis
- Diagnosing thoracic outlet syndrome can be difficult because the symptoms and their severity can vary greatly among people with the disorder. To diagnose thoracic outlet syndrome, your doctor may review your symptoms and medical history and conduct a physical examination. 1. P…
Lifestyle and Home Remedies
- If you're diagnosed with thoracic outlet syndrome, your doctor or physical therapist will instruct you to do exercises at home to strengthen and support the muscles surrounding your thoracic outlet. In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet: 1. Maintain good posture 2. Take frequent breaks at work to move and stretch 3…
Coping and Support
- Symptoms associated with thoracic outlet syndrome can be caused by a number of other conditions, which makes it difficult for doctors to diagnose the condition. Many people experience thoracic outlet syndrome symptoms for years before they are diagnosed with the condition, which can cause stress and frustration. Be sure to discuss your concerns with your doctor if your sym…
Preparing For Your Appointment
- You're likely to start by seeing your primary care doctor. In some cases, your doctor may refer you to a doctor trained in blood vessel (vascular) conditions or blood vessel surgery. Here's some information to help you prepare for your appointment.