Thoracic outlet syndrome: A real pain in the neck

Published: May. 16, 2016 at 3:39 PM EDT
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Imagine being injured by your own bones or muscles. That’s what happens to patients with thoracic outlet syndrome, a condition that goes misdiagnosed in many. If proper treatment is given right away, patients could be cured for good.

Jamila Crooks said, “The last three years have been stressful. Holding a coffee cup was very difficult. Going from doctor to doctor not being able to pinpoint what was really wrong.”

Crooks had no idea what was causing the pain, until she met Dr. Karl Illig. He told her she had thoracic outlet syndrome.

“I was just so relieved to know that I’m not crazy,” explained Crooks.

Thoracic outlet syndrome, or TOS, affects a complex area at the base of the neck where arteries, veins or nerves can be squeezed.

Karl Illig, M.D., director of vascular surgery and professor of surgery at University of South Florida Morsani College of Medicine and a staff surgeon at Tampa General Hospital said, “The space through which those structures have to go is inadequate.”

Crooks’ pain can be traced back to a car accident. But Dr. Illig said TOS can strike athletes, musicians and anyone who does repetitive overhead motions.

Physical therapy can resolve minor symptoms, but if that doesn’t work surgery is typically the best option.

“In neurogenic TOS, we would remove the rib, ideally remove both muscles and ideally remove the scar tissues from the nerves although there are several different ways of doing this,” explained Dr. Illig.

“It’s helped a lot. I am able to do things that I was doing before,” said Crooks.

Without a pain in the neck to bring her down.

Dr. Illig said there are only about 12 to 15 centers around the country that specialize in treating thoracic outlet syndrome. There are three different kinds of TOS. One affects the veins and one that affects nerves. The artery can also be affected but this is rare.

BACKGROUND: Thoracic outlet syndrome (TOS) occurs when there is compression, injury, or irritation of the nerves or blood vessels in the lower neck and upper chest area. TOS is named for the space between the lower neck and upper chest where the grouping of nerves and blood vessels can be found. The condition can be caused by an extra first rib or an old fracture of the collarbone that reduces the space for the vessels and nerves. Other causes for TOS are bony and soft tissue irregularities. Thoracic outlet syndrome affects people of all ages and gender, but it is most common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, and other sports. Neurogenic TOS (TOS that affects the nerves) is the most common form of the disorder with 95% of people with TOS having this form of the disorder. In general, TOS is more common in women than men, particularly among those with poor muscular development, poor posture or both.


SYMPTOMS AND RISK FACTORS: There are three different kinds of TOS. One affects the veins; another affects the nerves and one affects the artery. TOS that affects the artery is very rare. Symptoms of neurological thoracic outlet syndrome can include numbness or tingling in arm or fingers, pain or aches in the neck, shoulder or hand and a weakening grip. Symptoms of vascular thoracic outlet syndrome (TOS that affects the veins) can include throbbing lump near the collarbone, lack of color in one or more fingers or entire hand and arm pain and swelling, possibly due to blood clots. The following may increase the risk of developing TOS:

* Sleep disorders

* Tumors or large lymph nodes in the upper chest or underarm area

* Stress or depression

* Participating in sports that involve repetitive arm or shoulder movement, such as baseball, swimming, golfing, volleyball and others

* Repetitive injuries from carrying heavy shoulder loads

* Injury to the neck or back (whiplash injury)

* Poor posture

* Weightlifting


TREATMENT: Physical therapy, medications or surgery are used to treat thoracic outlet syndrome. Physical therapy is the first line of treatment in which a patient learns how to do exercises that will strengthen and stretch their shoulder muscles to open the thoracic outlet, improve the range of motion and improve their posture. Done over time, these exercises may take the pressure off the blood vessels and nerves in the thoracic outlet. A doctor may prescribe anti-inflammatory medications such as ibuprofen, pain medications or muscle relaxants to decrease inflammation, reduce pain and encourage muscle relaxation. Doctors may also prescribe clot-dissolving medications since venous or arterial thoracic outlet syndrome can cause blood clots in a patient's veins or arteries. Surgery may be recommended if other treatments haven't been effective.