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SALT LAKE CITY — If you have pain, numbness or tingling in your arms or hands, don't delay seeing a doctor. These and other symptoms can indicate a condition known as thoracic outlet syndrome (TOS), which can lead to permanent nerve damage.
Thoracic outlet syndrome
The Cleveland Clinic defines TOS as "a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area."
Basically, this means that the blood vessels and nerves that pass through a narrow space near your shoulder and collarbone — for a variety of reasons — have become pinched or otherwise compressed. This usually results in pain and weakness to the arms and tissue.
People who have the disorder usually have a history of disease, injury to the shoulder, or overuse of the shoulder (like baseball pitchers). Sometimes even the constant weight of heavy backpacks can contribute to the problem.
Sometimes TOS can occur because a person has an extra rib above the first rib or an abnormal tight band connecting the spine to the ribs. And another group of people who are at risk have a body type of long necks and droopy shoulders.
Symptoms and treatment
Symptoms of TOS include:
- Pain, numbness and tingling in the pinky and ring fingers on the affected arm
- Pain and tingling in the neck and shoulder of the affected arm
- Decreased blood flow in the hand or forearm of the affected arm (bluish colored skin, cold and swollen hands)
- Muscle weakness in the affected arm
This diagnosis of TOS is made by several tests and a process of elimination. This can be as simple as a physical exam by your doctor or as complicated as a nerve conduction velocity study, and everything in between.
In the early stages of treatment, physical therapy is often used to increase shoulder strength and range of motion and to improve posture. Pain medication is often prescribed to help with the constant pain associated with nerve entrapment, and blood-thinning medications can be used to lessen the chance of blood clots.
More advanced treatments include:
- Angioplasty or blood vessel X-ray study/treatment
- Surgery on the armpit, collarbone or removal of an extra rib (when applicable)
- Bypass surgery to reroute blood supply
If you feel you have symptoms of TOS, do not delay a visit with your health care professional. Nerve damage will not improve even with surgery if you let it go too long before treatment.
Suzanne Carlile, "Nurse Suzy," has been a nurse since 1982. Her main focus is critical care and nursing education. She holds a master's degree in nursing, is a Certified Emergency Nurse, and a member of NNSDO Intermountain West Chapter.
