Thoracic Outlet Syndrome (TOS) is a condition that affects the shoulder, arm and hand. It is characterized by pain, weakness and numbness in these areas. TOS occurs when the 5 major nerves and 2 main arteries that leave the neck become compressed between the two scalene muscles in the front of the neck and the first rib. TOS is caused by repetitive actions with the arms held overhead or extended forward, which can result in irritation and compression in this area. In addition, Forward Head Posture, slouching or dropping the shoulders forward can cause tension in the muscles at the side of the neck, which constricts arteries and nerves and contributes to TOS. Other causes of TOS include an extra first rib or an old collarbone fracture, since these both limit space in this region. Injuries that tear the scalene muscles of the neck, such as whiplash, can lead to a buildup of scar tissue, which also restricts space around the nerves and arteries, leading to TOS.
Symptoms of TOS can include pain, weakness, numbness, tingling, swelling, fatigue, or coldness in arms and hands. Waking up with a "dead arm" is also characteristic of TOS. TOS is often difficult to diagnose since its symptoms mimic those of other conditions, such as Herniated Cervical Disk, Carpal Tunnel Syndrome, or bursitis of the shoulder.
People at risk for developing TOS include people whose occupations involve repetitive actions with the arms extended, such as computer users, waiters and painters.
Prevention of TOS includes taking frequent breaks from repetitive tasks, doing stretching and strengthening exercises for the back, neck and shoulders, adopting an ergonomic workstation arrangement, practicing proper posture at the computer, and by limiting the amount of time spent with arms extended or doing repetitive tasks.
Treatment for TOS includes rest, doing stretching and strengthening exercises for the back, neck and shoulders, adopting an ergonomic workstation arrangement, and using proper posture at the computer. Depending on the cause, physical therapy, chiropractic care, or medication may be useful.
Cervical Radiculopathy means “pinched nerve.” It presents with pain in shoulder, elbow, or forearm. The pain often has a burning quality. A patients may have numbness in the elbow, forearm, or hand. Sometimes the pain is increased with straining (coughing, sneezing, bowel movement).
Physical exam will be aimed at demonstrating nerve root compression. Many different maneuvers may be done by physicians. Assessment of muscle strength and reflexes is also important.
Imaging procedures such as MRI or electrical tests may also be useful.
Treatment includes rest (sometimes using a soft cervical collar), anti inflammatory drugs, and physical therapy. Traction, transcutaneous nerve stimulation, and moist heat supplemented by a stretching and strengthening exercise program are warranted for people with continuing discomfort.
Surgery is indicated if pain prevents patient from functioning, or if there is spinal cord compression, or weakness.