Thoracic Outlet Syndrome (TOS)
TOS refers to a group of disorders caused by compression of nerves, blood vessels, or both in the thoracic outlet— a space that lies behind the collarbone in the front of the neck and is bordered in the back by the first rib. Thoracic outlet syndrome can lead to pain, weakness, or other symptoms in the neck, shoulders, arms, and fingers. It often affects daily activities and overall quality of life.
What causes Thoracic Outlet Syndrome (TOS)?
TOS can develop due to various factors, including:
- Repetitive movements: overhead or repetitive arm activities, common in certain occupations or sports.
- Anatomical abnormalities: extra cervical ribs or tight fibrous bands compressing the thoracic outlet.
- Trauma: injury from accidents or falls can impact the neck, first rib, and shoulder area.
- Poor posture: prolonged forward head posture or slouched shoulders contributing to compression.
- Myofascial pain syndrome (MFPS): compression in the brachial plexus nerve branches when present in the scalenes or pectoralis muscles.
- Pregnancy: increased susceptibility due to hormonal and physical changes during pregnancy.
Symptoms of Thoracic Outlet Syndrome (TOS)
Symptoms vary, depending on the type of compression.
- Neurogenic TOS (the most common form):
- Numbness, tingling, or weakness in the arm and hand.
- Pain in the neck, shoulder, wrist, or hand.
- Difficulty gripping or performing fine motor tasks.
- Fatigue with reduced stamina throughout the entire arm during use.
- Vascular TOS:
- Swelling, discoloration, or coldness in the arm or hand.
- Throbbing pain and a feeling of heaviness.
- Nonspecific TOS:
- Chronic pain and fatigue without clear nerve or vascular involvement.
Diagnosing Thoracic Outlet Syndrome (TOS)
A combination of clinical evaluation and diagnostic tools are needed to rule out other conditions that mimic TOS, like a pinched cervical nerve or a combination of musculoskeletal issues in the shoulder and elbow. Key diagnostic steps include taking a detailed medical history and conducting a thorough physical examination. Specific tests are often conducted to evaluate nerve function and identify compression points. Advanced imaging, such as electrodiagnostic nerve testing, or brachial plexus MRI, may be utilized to confirm the diagnosis, help pinpoint nerve or vessel compression, and assess severity.
Nonsurgical Treatment for Thoracic Outlet Syndrome (TOS)
The Orthohealing Center offers several noninvasive and minimally invasive therapies designed to address the root causes of neurogenic thoracic outlet syndrome and restore function. Our innovative treatment options include:
- Platelet lysate or alpha 2 macroglobulin (A2M): administered to the brachial plexus sheath to enhance healing and reduce inflammation around injured nerves.
- Prolotherapy: aimed at strengthening ligaments and improving stability in the thoracic outlet region to alleviate compression, it is especially useful when a weak rib joint or shoulder joint is causing secondary MFPS.
- Therapeutic Botox: administered to persistently tight muscles that are compressing the brachial plexus nerves.
- Ultrasound-guided scalene blocks: used to precisely target affected areas with medication (including anesthetic) to reduce pain and improve mobility.
We combine cutting-edge regenerative approaches with holistic care, tailoring treatment plans to each patient’s specific needs. By focusing on long-term healing and symptom resolution, our objective is to restore mobility, eliminate pain, and improve quality of life.
