Neurogenic Thoracic Outlet Syndrome

Understanding Neurogenic Thoracic Outlet Syndrome: Causes, Symptoms, and Treatment

Introduction

Neurogenic Thoracic Outlet Syndrome (TOS) is a condition that occurs when the nerves supplying the arms and hands, known as the brachial plexus nerves, are compressed or squeezed as they pass through a tight space under the collarbone and above the top rib, called the thoracic outlet. This type of TOS is the most common and can result in symptoms on one or both sides of the body. In this article, we will explore the causes, symptoms, and treatment options for neurogenic TOS.

Causes of Neurogenic Thoracic Outlet Syndrome

Neurogenic TOS is typically caused by the narrowing of the thoracic outlet due to swelling or scarring in the neck muscles. Several factors can contribute to this condition, including:

1. Neck Injuries: Traumatic neck injuries, such as those from motor vehicle collisions (whiplash) or falls, can lead to nerve compression in the thoracic outlet.
2. Repetitive Stress on the Neck: Activities that involve repetitive stress on the neck, especially if the arms are elevated, such as working on a keyboard all day or performing assembly line tasks, can contribute to TOS.
3. Other Neck, Shoulder, or Arm Injuries: Various injuries in the neck, shoulder, or arm region can lead to the development of neurogenic TOS.

Risk Factors for Neurogenic Thoracic Outlet Syndrome

Several factors may increase the likelihood of developing neurogenic TOS:

1. Neck Injury: A previous neck injury increases the risk of nerve compression in the thoracic outlet.
2. Repetitive Stress on the Neck: Jobs or activities that involve repetitive stress on the neck can heighten the risk of TOS.
3. Gender: Women are more susceptible to neurogenic TOS.
4. Weight: Being overweight can be a risk factor for developing this condition.
5. Poor Posture: Individuals with poor posture are at an increased risk of TOS.
6. Cervical Rib: Having an extra rib (cervical rib) can contribute to nerve compression in the thoracic outlet.
7. Pregnancy: Loosening of joints during pregnancy can also increase the risk of TOS.

Signs and Symptoms of Neurogenic Thoracic Outlet Syndrome

The symptoms of neurogenic TOS may include:

1. Pain in the arm, particularly when at rest.
2. Numbness or tingling in the hand.
3. Decreased strength in the arm.
4. Muscle loss in the hands (rare).

Symptoms may worsen when holding the arms over the head.

Diagnosis of Neurogenic Thoracic Outlet Syndrome

Diagnosing neurogenic TOS involves a combination of physical examinations and imaging studies, including:

1. Physical Exam: Healthcare providers may ask patients to perform certain arm positions to assess whether symptoms worsen.
2. Imaging Studies: X-rays, ultrasound, CT scans, MRI, venograms, angiograms, pulse volume recording, and nerve conduction tests are performed to confirm the diagnosis and identify the underlying cause of TOS.

Treatment of Neurogenic Thoracic Outlet Syndrome

The treatment for neurogenic TOS may include:

1. Physical Therapy: Patients may undergo physical therapy to learn stretching exercises and improve posture.
2. Occupational Therapy: Occupational therapy can help optimize the workplace and home setup for better arm and neck support.
3. Medication: Pain medicine, muscle relaxants, and anti-inflammatory drugs may be prescribed to manage symptoms.
4. Surgery: In rare cases, surgery may be necessary to remove scarred neck muscles or the first rib to relieve nerve compression.

Self-Care Tips for Managing Neurogenic Thoracic Outlet Syndrome

At home, individuals can follow these self-care tips:

1. Activity: Perform stretching exercises and follow the recommendations of your healthcare provider or physical therapist.
2. Posture: Maintain good posture to reduce stress on the neck and shoulders.
3. Lifting Restrictions: Avoid lifting heavy objects (over 10 lb or 4.5 kg) until cleared by your healthcare provider.
4. Repetitive Tasks: Take frequent breaks to stretch and rest your arms if you engage in repetitive hand and arm work, such as typing.
5. Weight Management: Maintain a healthy weight and follow weight loss advice from your healthcare provider if necessary.
6. Medication Use: Take over-the-counter and prescription medicines only as instructed by your healthcare provider.
7. Follow-Up Visits: Attend all scheduled follow-up visits as directed by your healthcare provider.

Conclusion

Neurogenic Thoracic Outlet Syndrome occurs when the nerves supplying the arms and hands are compressed in the thoracic outlet. It can be caused by swelling or scarring in the neck muscles. Symptoms may include arm pain, numbness, tingling, and decreased arm strength. Treatment options include physical therapy, occupational therapy, medication, and surgery. Following self-care tips and seeking medical guidance are essential in managing and alleviating symptoms. Always consult your healthcare provider for personalized advice and treatment.