Thoracic Outlet Syndrome

Symptoms of Thoracic Outlet Syndrome

Symptoms of thoracic outlet syndrome are reproduced when the arm is extended or raised above the shoulder. This movement puts extra pressure on the thoracic outlet space and causes compression of the structures in the area such as the nerves and blood vessels responsible for circulation and nerve signal transmission in the shoulders, neck, arms and hands. Pain can be felt acutely, chronically, intermittently, as a dull ache, or as intense burning or stabbing pain. Symptoms vary from person to person but generally include arm, shoulder, and neck pain with numbness and/or impaired circulation to the hands. Fingers may turn a bluish colour as the circulation is reduced to the area. As the blood flow returns this may cause intense pain such as is experienced by those with Raynaud’s disease. Weakness of the arms and hands, with reductions in manual dexterity, grip strength, and ability to conduct simple tasks, such as opening a jar, can all be signs of thoracic outlet syndrome.

Neurogenic TOS Symptoms

If neurogenic thoracic outlet syndrome is present then the patient is likely to feel pins and needles upon raising the affected arm above the shoulder. The presence of Gillat-Summer hand characterizes this condition and is noticeable as severe wasting of the flesh at the base of the thumb. Numbness, dull aching, or pain in the neck, shoulder and armpit are also symptoms of neurogenic thoracic outlet syndrome, as is loss of sensation along the bottom of the hand and arm. These symptoms may be confused with carpal tunnel syndrome in some cases, but are not part of the same condition.

Vascular TOS Symptoms

Vascular thoracic outlet syndrome commonly presents with a pallor to the palm in the affected hand, making the hand cold to touch, and spreading that circulatory loss up into the affected arm. This is likely to be increased or reproduced upon raising the affected arm and can lead to a noticeably different color in one arm from the other. The arm may also feel unnaturally heavy and numb and symptoms may appear in tandem with those of neurogenic thoracic outlet syndrome. Disputed or nonspecific thoracic outlet syndrome may preset with any or all of these symptoms and poses a difficult diagnostic puzzle for physicians.

Overlapping Symptoms

Commonly, symptoms are considered similar to those of herniated cervical discs, pinched nerves, and neurological damage. Diagnosis may be difficult due to the varied nature of the problem and the overlap of symptoms with more recognized conditions. Ensuring a full and frank disclosure of sensations, including their frequency, intensity, precipitating factors, and duration can aid a physician in making a diagnosis. Remaining stoic in the face of pain does not lead to a prompt diagnosis and adequate treatment. If the symptoms are acute and involve chest and neck pain with radiating pain down the arm then medical attention should be sought immediately as this can indicate alternative pathology such as a myocardial infarction (heart attack), or acute disc herniation in the cervical spine.

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Last Updated: 10/04/2010