Thoracic Outlet Syndrome
Disease Details
Family Health Simplified
- Description
- Thoracic outlet syndrome (TOS) is a group of disorders characterized by compression of nerves and blood vessels between the collarbone and the first rib, causing pain, numbness, and weakness in the neck, shoulder, and arm.
- Type
- Thoracic outlet syndrome (TOS) is primarily a non-genetic condition caused by compression of nerves or blood vessels in the thoracic outlet (the space between the collarbone and first rib). It is usually due to physical trauma, repetitive strain, anatomical defects, or tumors. There is no known type of genetic transmission for thoracic outlet syndrome.
- Signs And Symptoms
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TOS affects mainly the upper limbs, with signs and symptoms manifesting in the shoulders, neck, arms and hands. Pain can be present on an intermittent or permanent basis. It can be sharp/stabbing, burning, or aching. TOS can involve only part of the hand (as in the pinky and adjacent half of the ring finger), all of the hand, or the inner aspect of the forearm and upper arm. Pain can also be in the side of the neck, the pectoral area below the clavicle, the armpit/axillary area, and the upper back (i.e., the trapezius and rhomboid area). Discoloration of the hands, one hand colder than the other hand, weakness of the hand and arm muscles, and tingling are commonly present.Only 1% of people with carpal tunnel syndrome have concomitant TOS.Repetitive motions can cause enlargement of muscles which causes compression of veins. Besides, overuse injury of the upper limbs causes swellings, small bleeding, and subsequent fibrosis which would cause the thrombosis of the subclavian vein, leading to Paget–Schroetter disease or effort-induced thrombosis.TOS can be related to cerebrovascular arterial insufficiency when affecting the subclavian artery. It also can affect the vertebral artery, in which case it could produce vision disturbances, including transient blindness, and embolic cerebral infarction.TOS can also lead to eye problems and vision loss as a circumstance of vertebral artery compression. Although very rare, if compression of the brain stem is also involved in an individual presentation of TOS, transient blindness may occur while the head is held in certain positions.
If left untreated, TOS can lead to neurological deficits as a result of the hypoperfusion and hypometabolism of certain areas of the brain and cerebellum.TOS has similar symptoms to pectoralis minor syndrome (PMS), which usually results from compression of the braxial plexus beneath the pectoralis minor muscle (while neurogenic TOS is caused by compression of the same nerves above the clavicle). Unlike TOS there is typically few headaches or neck pain in patients with PMS only, instead with pain in the chest area. Initially, it was believed that 95 percent of patients with TOS had nerve compression in the scalene area, but in the twenty-first century it is now recognized that the majority have nerve compression under the pectoralis minor, either by itself or in addition to the scalene area. One study of 100 patients diagnosed with neurogenic TOS found that 75 percent had neurogenic PMS and 30 percent in fact had PMS without TOS. - Prognosis
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Thoracic outlet syndrome (TOS) encompasses a group of disorders that occur when blood vessels or nerves in the space between your collarbone and first rib (thoracic outlet) are compressed. The prognosis for TOS varies depending on the cause and severity of the condition, as well as the effectiveness of treatment.
- **Mild Cases**: With appropriate physical therapy, postural adjustments, and exercises, individuals can experience significant relief and return to normal function.
- **Moderate Cases**: May require a combination of physical therapy and medications. The prognosis is generally good if patients adhere to treatment regimens.
- **Severe Cases**: Surgery might be necessary to relieve compression. The success rates for surgical interventions are generally high, but recovery times can vary, and some individuals may still experience residual symptoms.
Overall, early diagnosis and treatment play a critical role in improving outcomes for individuals with thoracic outlet syndrome. - Onset
- Thoracic outlet syndrome (TOS) often has an insidious onset, where symptoms develop gradually over time. It may initially appear with intermittent pain, tingling, or weakness in the neck, shoulder, or arm, which can progressively worsen without intervention.
- Prevalence
- The prevalence of thoracic outlet syndrome (TOS) is not precisely established, but it is considered a relatively uncommon condition. Estimates suggest it affects about 1 to 2 per 1,000 people, although this can vary based on the specific type of TOS and the population being studied.
- Epidemiology
- Thoracic Outlet Syndrome (TOS) is a condition involving compression of nerves, arteries, or veins in the thoracic outlet, the space between the collarbone and first rib. Epidemiologically, TOS is relatively rare. It affects approximately 3 to 80 out of 1,000 people, with variations depending on the diagnostic criteria and population studied. The syndrome commonly occurs in individuals aged 20 to 50, with a higher prevalence in women. Specific risk factors include repetitive arm movements, anatomical abnormalities, and certain occupations requiring overhead activities.
- Intractability
- Thoracic Outlet Syndrome (TOS) is not always intractable. Treatment options include physical therapy, pain management, and sometimes surgical intervention, which can be effective for many patients. The outcomes vary depending on the severity and specific type of TOS, but with appropriate treatment, many individuals experience significant relief.
- Disease Severity
- Thoracic outlet syndrome (TOS) severity can vary widely depending on the type and the underlying cause. It ranges from mild to severe and can significantly impact quality of life due to pain, numbness, and loss of function in the affected areas. Severe cases may require surgical intervention.
- Healthcare Professionals
- Disease Ontology ID - DOID:3103
- Pathophysiology
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Thoracic outlet syndrome (TOS) refers to 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 lead to pain in your shoulders and neck and numbness in your fingers.
Pathophysiology:
The pathophysiology of TOS involves the compression of the neurovascular structures as they pass through the thoracic outlet. This compression can occur due to anatomical variations, trauma, repetitive stress, or poor posture, leading to various symptoms based on the structures affected:
- Neurogenic TOS: Compression of the brachial plexus nerves, leading to pain, numbness, and weakness in the arm and hand.
- Venous TOS: Compression of the subclavian vein, resulting in swelling, pain, and potential blood clots in the arm.
- Arterial TOS: Compression of the subclavian artery, causing a weak or absent pulse in the affected arm, coldness, and paleness. - Carrier Status
- Thoracic outlet syndrome (TOS) is not a genetic condition, so concepts like carrier status do not apply. It is a group of disorders that occur when blood vessels or nerves in the thoracic outlet—the space between your collarbone and your first rib—are compressed. This can cause pain in the shoulders and neck and numbness in the fingers. Factors that may contribute to TOS include anatomical defects, poor posture, trauma, repetitive activity, and certain physical activities.
- Mechanism
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Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures—specifically the brachial plexus, the subclavian artery, and the subclavian vein—at the thoracic outlet, which is the space between the collarbone and the first rib.
### Mechanism:
The compression can occur due to various reasons:
1. **Anatomic Variations:** Extra cervical ribs, abnormal scalene muscles, or an abnormal first rib can reduce the space within the thoracic outlet.
2. **Postural Issues:** Poor posture can decrease the space and cause compression.
3. **Trauma:** An injury to the neck or shoulder region can lead to swelling or structural changes contributing to TOS.
4. **Repetitive Stress:** Occupational or recreational activities that require repetitive arm movements can lead to soft tissue changes and contribute to compression.
### Molecular Mechanisms:
There is limited specific information on the precise molecular mechanisms directly causing TOS, but a few relevant aspects include:
1. **Inflammatory Pathways:** Repetitive stress or trauma may induce localized inflammation, leading to fibrosis and structural changes, mediated by cytokines and growth factors.
2. **Neurogenic Factors:** In cases of nerve compression, the injury to nerve tissue can set off a cascade involving axonal damage, demyelination, and subsequent release of molecules such as nerve growth factors that can aggravate pain and dysfunction.
3. **Vascular Factors:** Compression of vascular structures can lead to endothelial damage and release of factors such as nitric oxide and endothelin-1, which can contribute to vascular dysfunction and symptoms.
Further research is needed to completely elucidate the molecular pathways involved in TOS, particularly regarding the interplay of biomechanical and biochemical factors leading to the condition. - Treatment
- Evidence for the treatment of thoracic outlet syndrome as of 2014 is poor.
- Compassionate Use Treatment
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Thoracic Outlet Syndrome (TOS) treatment options under compassionate use, off-label, or experimental categories might include:
1. **Compassionate Use Treatment**: This typically involves access to investigational treatments that are still in clinical trials and not yet approved by regulatory bodies. Patients with severe or refractory TOS might obtain access through specific programs at treating institutions.
2. **Off-label Treatments**:
- **Botulinum Toxin Injections**: Although primarily used for muscle spasticity and cosmetic purposes, botulinum toxin can be administered off-label to relieve muscle tightness and reduce symptoms in certain TOS cases.
- **Gabapentin or Pregabalin**: These medications are often used for neuropathic pain and may be used off-label to manage pain associated with TOS.
3. **Experimental Treatments**:
- **Stem Cell Therapy**: This is an emerging treatment under investigation for various musculoskeletal disorders, including TOS.
- **Platelet-Rich Plasma (PRP) Injections**: PRP therapy is being explored for its potential to promote healing and reduce inflammation in TOS patients.
These treatments should always be discussed with a healthcare provider to understand the potential risks, benefits, and current evidence supporting their use. - Lifestyle Recommendations
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Thoracic Outlet Syndrome (TOS) 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. Here are some lifestyle recommendations for managing TOS:
1. **Exercise Regularly:** Engage in gentle stretching and strengthening exercises, particularly those that focus on the shoulder muscles and upper back to improve posture and relieve pressure.
2. **Posture Improvement:** Maintain good posture to help reduce the strain on your thoracic outlet. Sit and stand up straight, and avoid slouching.
3. **Ergonomic Adjustments:** Make ergonomic adjustments to your workspace. Ensure your chair, desk, and computer setup promote good posture and minimize strain on your shoulders and arms.
4. **Avoid Repetitive Activities:** Limit activities that require repetitive or prolonged movements of the shoulders and arms. Take frequent breaks to rest your muscles.
5. **Weight Management:** Maintain a healthy weight to reduce stress on your body and potentially improve symptoms.
6. **Pain Management:** Use pain relief techniques such as ice packs, heat pads, or over-the-counter pain relievers as recommended by a healthcare provider.
7. **Physical Therapy:** Participate in physical therapy sessions as prescribed to improve strength, flexibility, and range of motion.
8. **Lifestyle Modifications:** Avoid carrying heavy bags over your shoulder and overhead activities that could exacerbate symptoms.
Following these lifestyle recommendations can help manage and potentially alleviate the symptoms of Thoracic Outlet Syndrome. - Medication
- In a review, botox was compared to a placebo injected into the scalene muscles. No effect in terms of pain relief or improved movement was noted. However, in a six-months follow-up, paresthesia (abnormal sensations such as in pins and needles) was seen to be significantly improved.
- Repurposable Drugs
- There are no specifically repurposable drugs that are widely recognized for treating thoracic outlet syndrome (TOS). TOS is commonly managed through physical therapy, pain relief medications, and in severe cases, surgery. Some medications used to manage symptoms include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and pain medications. However, none of these are repurposed specifically for TOS.
- Metabolites
- Thoracic Outlet Syndrome (TOS) is a condition caused by the compression of nerves, blood vessels, or both, in the thoracic outlet. This typically does not result in specific changes to identifiable metabolites in the blood or urine that are used for diagnosis or management. The condition is primarily diagnosed based on clinical symptoms, physical examination, and imaging studies.
- Nutraceuticals
- There is limited evidence to support the use of nutraceuticals specifically for Thoracic Outlet Syndrome (TOS). Treatment typically focuses on physical therapy, pain relief, and sometimes surgical intervention. It’s important to consult healthcare providers for a tailored treatment plan. Nutraceuticals, such as anti-inflammatory supplements, might be considered adjunctive therapies but should not replace standard treatments.
- Peptides
- Thoracic Outlet Syndrome (TOS) is a condition caused by the compression of nerves, arteries, or veins in the thoracic outlet, the space between the collarbone and first rib. Peptides are short chains of amino acids, and while they play various roles in the body, there are no specific peptides currently approved or widely recognized for the treatment of TOS. Research in this area may be ongoing, but no definitive peptide-based treatments are established for TOS as of now.