Thoracic outlet syndrome is pressure on nerves that causes pain, numbness, and tingling in your fingers, hand, arm, or shoulder. The thoracic outlet is a passageway for nerves and blood vessels between your neck and armpit.
What is the cause?
Thoracic outlet syndrome happens when the passageway for nerves and blood vessels is blocked or narrowed. This can happen because of muscle tightness, exercise, injury, or pregnancy. Some people have this problem because they have an extra rib at the top of their rib cage.
Some activities or postures can lead to thoracic outlet syndrome. For example, if you stand for long periods of time at your job, you may droop your shoulders and lean your head forward a lot of the time, putting pressure on the thoracic outlet. This can also happen if you carry heavy loads on your shoulders. Playing a sport or doing work that involves repeated overhead arm movements can also cause thoracic outlet syndrome.
What are the symptoms?
Symptoms may include:
Tingling or numbness in the fingers, hand, arm, or shoulder
Weakness of a hand or arm
Swelling of a hand or arm
Aching in the shoulder
Symptoms may be worse when you lift your arm above your shoulder.
How is it diagnosed?
Your healthcare provider will ask about your symptoms, medical history, and activities and examine your neck, shoulder, arm, and hand. Tests may include X-rays or other scans.
Your provider may tap the middle of your inner wrist or ask you to bend your wrist down for 1 minute to see if either of these tests causes pain or tingling. Your provider may refer you to a specialist for tests to check your nerves.
How is it treated?
Treatment is aimed at reducing pressure on the thoracic outlet. Your healthcare provider may recommend stretching and strengthening exercises to help:
Improve your posture so you stand and sit straighter
Stretch tight tissue around the thoracic outlet
Strengthen the muscles in your shoulder and neck
If you are overweight, your provider may recommend losing weight.
Your provider may prescribe medicine for pain and swelling.
In rare cases your provider may recommend surgery if your symptoms donâ€™t get better with these treatments.
How can I take care of myself?
Follow the full course of treatment prescribed, including any exercises recommended by your provider. In addition:
You may need to change your workstation so you can have better posture while you work.
Avoid sleeping with your arm in an overhead position.
Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don’t take more than 3000 milligrams (mg) in 24 hours. To make sure you donâ€™t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
Ask your provider:
How and when you will hear your test results
How long it will take to recover
If there are activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
How can I help prevent thoracic outlet syndrome?
It helps if you:
Avoid repetitive overhead activities.
Take frequent breaks from your work.
Make sure your posture is good.
Donâ€™t carry heavy loads on your shoulders.
Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth. Last modified: 2014-10-24 Last reviewed: 2014-09-15
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Thoracic Outlet Syndrome: References
DeLee, Jesse C., David Drez, and Mark D. Miller, Orthopaedic Sports Medicine: Principles and Practice, Saunders; 2nd ed, 2002
Greene, Walter B., M.D., Griffin, Letha Y. (Ed), Essentials of Musculoskeletal Care, Amer Academy of Orthopaedic, 2005
Kisner, Carol, and Lynn Allen Colby, Therapeutic Exercise: Foundations and Techniques, F. A. Davis Company; 5th ed, 2007
Mellion, Morris B., W. Michael Walsh, Christopher Madden, Margot Putukian, and Guy L. Shelton, The Team Physician’s Handbook, Hanley & Belfus; 3 ed, 2001
Micheli, Lyle J. and Mark Jenkins, The Sports Medicine Bible: Prevent, Detect, and Treat Your Sports Injuries Through the Latest Medical Techniques, HarperCollins, 1995
Schepsis, Anthony, A., and Busconi, Brian D., Sports Medicine, Lippincott Williams & Wilkens, 2006.