Thoracic Outlet Syndrome

The thoracic outlet is a space between the rib cage (thorax), and the collarbone (clavicle) through which the main blood vessels and nerves pass from the neck and thorax into the arm. Thoracic outlet syndrome is a combination of pain, numbness, tingling, weakness, or coldness in the upper extremity caused by pressure on the nerves and/or blood vessels in the thoracic outlet. In some cases, the cause of compression is evident such as an extra first rib or an old fracture of the clavicle, which reduces the space of the outlet. Sometimes, if the shoulder muscles in your chest are not strong enough to hold the collarbone in place, it can slip down and forward, putting pressure on the nerves and blood vessels that lie under it. Poor posture or obesity also may contribute to the cause. Compression may also occur with repetitive activities that require the arms to be held overhead. In other cases, the cause is not clear.

Depending on the extent of compression, symptoms vary. Reduced pressure to the arms with compression makes one's arms feel cool and easily fatigable. Pressure on the nerves causes a vague aching pain in the neck, shoulder, arm, and hand.

The treatment for thoracic outlet syndrome is usually symptomatic including analgesics and physical therapy to increase range of motion of the neck and shoulders, strengthen muscles, and induce better posture. For most, prognosis for recovery is good. Surgery is usually not required unless there is an obvious compression, particularly by a bone.

The following simple exercises are recommended if you have thoracic outlet syndrome to strengthen your shoulder muscles. Try to do 10 repetitions of each exercise twice daily. However, if you experience any pain with the exercise recommendations, you should stop.

• Corner Stretch: stand in a corner (about one foot away from the corner) with your hands at shoulder height, one on each wall. Lean into the corner until you feel a gentle stretch across your chest. Hold for 5 seconds.
• Neck Stretch: put your left hand on your head, and your right hand behind your back. Pull your head toward your left shoulder until you feel a gentle stretch on the right side of your neck. Hold for 5 seconds. Switch hand positions and repeat the exercise in the opposite direction.
• Shoulder Rolls: shrug your shoulders up, back, and then down in a circular motion.
• Neck Retraction: pull your head straight back, keeping your jaw level. Hold for 5 seconds.