Can The Pain In My Arm Actually Be Caused By Thoracic Outlet Syndrome (TOS)?

 

Thoracic-Outlet-Syndrome-TOS

 

Thoracic Outlet Syndrome (TOS) can be an extremely painful and debilitating condition of the thoracic-outlet-syndrome-2-638upper extremity.  It is caused by the compression of structures in the thoracic outlet, a space just behind the clavicle (collar bone) and just above the 1st rib.  Because of a multitude of signs and symptoms that can lead to a diagnosis of Thoracic Outlet Syndrome, the incidence rates of this condition are currently unknown.  Physical Therapy is very instrumental in easing the symptoms of Thoracic Outlet Syndrome and restoring upper extremity function in those individuals.

 

What Does Thoracic Outlet Syndrome Feel Like?

 

Thoracic Outlet Syndrome Definition(3)Because Thoracic Outlet Syndrome is generally classified by the type of structures compressed, there may be a vast array of symptoms.  However, it is thought that 90% of Thoracic Outlet Syndrome cases are neurogenic (nerve compression) in nature (categories 3 and 4 below).

Arteriole Thoracic Outlet Syndrome

  • Pain in the hand–rarely in the neck or shoulder
  • Numbness and tingling
  • Coldness or cold intolerant

Venous Thoracic Outlet Syndrome

  • Pain in the arm
  • Swelling in the arm
  • A feeling of heaviness in the arm
  • Numbness/tingling in the hands/fingers
  • Change in color of the arm (bluish color)

True Neurogenic Thoracic Outlet Syndrome

  • Pain/numbness/tingling in the shoulder, arm, and hand (and often the neck as well)
  • 316495_1_En_84_Fig2_HTMLNumbness/tingling of the arm (often times waking the person up at night)
  • Clumsiness of the hand
  • Headaches
  • Intolerance to cold
  • Coldness and color changes in the hand

Disputed Neurogenic Thoracic Outlet Syndrome

  • Pain/numbness/tingling in the shoulder, arm, and hand (and often the neck as well)
  • Numbness/tingling of the arm (often times waking the person up at night)
  • Clumsiness of the hand
  • Headaches
  • Intolerance to cold
  • Coldness and color changes in the hand
  • Symptoms much more intense at night vs during the day
  • Diagnostic tests may come back “normal” (thus the term “disputed”)

 

How Is Thoracic Outlet Syndrome Diagnosed?

 

Your Physical Therapist should conduct  a detailed medical history as well as a thorough evaluation.  During the evaluation they should look for any changes in color in the affected area and gently try to provoke symptoms by moving the involved arm in different directions.  Because of its effects on your physical function, your Physical Therapist may ask you questions such as:

  • When did you first notice the symptoms, and when are they the worst?
  • Have you noticed any changes in the appearance of your arm or hand?
  • Have you noticed that your physical tasks that require hand movements have changed significantly?
  • Have you noticed any change in symptoms with changes in temperature?

Once your Physical Therapist has ruled out other conditions that can mimic Thoracic Outlet Syndrome, they may refer you for specific diagnostic testing to confirm the diagnosis.  This would include a Doppler ultrasound (to confirm Arterial or Venous Thoracic Outlet Syndrome), or Nerve Conduction Velocity (NCV) testing (to confirm True Neurogenic Thoracic Outlet Syndrome).

 

 

How Can Physical Therapy Help?

 

Once your diagnosis of Thoracic Outlet Syndrome is confirmed, your Physical Therapist thoracic-outletshould work with you to develop a treatment plan to help decrease your discomfort and improve your ability to perform your normal everyday tasks.  Physical Therapy treatments should include:

Manual Therapy–Hands-on treatment to mobilize the nerves of the arm to help alleviate symptoms such as pain, numbness, and tingling.  This may also include gentle mobilization of the 1st rib and/or clavicle (collar bone).

Stretching the side of the neckMobility and Strengthening Exercises–Muscle strengthening exercises to increase movement and strength in the involved upper extremity.

Activity Modification and Postural Strategies–Positions and techniques to minimize stress and strain placed on the structures involved with Thoracic Outlet Syndrome.

Education–Strategies to help minimize your symptoms while performing your normal everyday activities.

 

Can Thoracic Outlet Syndrome Be Prevented?

 

photo-on-2012-03-07-at-19-54Unfortunately, some cases of Thoracic Outlet Syndrome cannot be prevented.  These cases would be due to trauma, space-occupying lesions (e.g. tumors), congenital conditions, or even anatomical variations.  Understanding the risk factors that could make you more susceptible to this condition is the first and most important step in prevention.  Your Physical Therapist can work with you to develop strategies so that you can better understand and manage your symptoms and risk factors.  Knowing strategies to reduce symptoms while performing activities can help you lead a full and functional life after the onset of Thoracic Outlet Syndrome.

 

If you or someone you know has signs and symptoms of Thoracic Outlet Syndrome, don’t wait to take action.  Call my office at once at (302)691-9055 or visit my website at www.wildermanphysicaltherapy.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help you.  Don’t delay-schedule now!

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