Thoracic Outlet Syndrome: Causes, Symptoms, Treatment and Cost

Thoracic Outlet Syndrome (TOS) is a disorder that manifests itself when the neurovascular bundle in the thoracic outlet is compressed. This may lead to a variety of symptoms. This bundle includes the brachial plexus nerves and subclavian artery and vein.

The three types of TOS are classified by what structures are compressed:

• Neurogenic TOS (nTOS): Compression of the nerve bundle that constitutes the brachial plexus and travels via the thoracic outlet. This type of TOS is more common in young, active individuals.
• Vascular TOS (vTOS): Compression of vascular structures such as arteries or veins running through the thoracic outlet. Vascular TOS often affects people older than age 40 who have atherosclerosis (hardening of the arteries).
• Combined Neurogenic-Vascular TOS: This uncommon form involves both nerve and vascular compression at once in the thoracic outlet area, resulting in a combination of symptoms from nTOS and vTOS conditions.

• Physical trauma: TOS may be caused by physical trauma such as a direct blow to the neck or shoulder, whiplash, or a fall on an outstretched arm.
• Repetitive motions: Throwing a ball, carrying heavy items, typing on a computer, and other repetitive activities may lead to TOS.
• Poor posture: Incorrect posture can put excessive strain on the muscles and nerves in the thoracic outlet area leading to TOS.
• strong>Anatomical abnormalities: Anomalies such as an extra rib (cervical rib) or an abnormal first rib can compress nerves and vessels in the thoracic outlet area causing TOS symptoms.
• Obesity: Weight gain might exacerbate the tension already placed on the muscles and nerves in this region, resulting in TOS symptoms.

Symptoms include:

• Pain and numbness in the arm, shoulder, and neck
• Weakness or heaviness in the arm or hand.
• Tingling and cold sensations in the arm and fingers.
• Difficulty using arms for repetitive movements, like combing hair or using scissors.
• Aches and pains in the head that start at the base of the skull and work their way up.
• Decreased mobility in the neck, arms, and shoulders.

• Stretch and strengthen the shoulder muscles with physical therapy.
• You should work on improving your posture, especially while you are sitting for long periods of time.
• Change repetitive activities at work or home that may cause too much strain on the shoulder and neck muscles.
• Avoid carrying heavy objects that place an excessive amount of tension on your shoulder and neck muscles.
• Support your arthritis with an ergonomic chair, a computer keyboard tray, or even wheelchair cushions to reduce pressure in the back and shoulders.

• Physical Examination: A physical examination is the first step in diagnosing thoracic outlet syndrome. During this exam, a doctor will check for physical signs of nerve compression, such as reduced movement and range of motion in the affected area.
• X-rays: X-rays of the bones in the neck and shoulder may be used to look for any narrowing of the spaces through which nerves pass.
• Electromyography (EMG): An EMG is a test that measures the electrical activity of muscles and nerves to evaluate nerve function. It can detect if a nerve is being compressed or if it is not functioning properly due to thoracic outlet syndrome.
• Ultrasound: Ultrasound imaging can be used to look for any swelling or changes in the muscles, tendons, and ligaments that are associated with thoracic outlet syndrome.
• Magnetic Resonance Imaging (MRI): An MRI scan uses magnetic fields to create detailed images of soft tissues such as muscles and tendons, which can help identify areas of compression or injury caused by thoracic outlet syndrome.

The following are examples of some of the issues that might arise from TOS:

• Pain: The most common symptom of thoracic outlet syndrome is pain in the affected area, usually around the neck, shoulder, and arm.
• Numbness or tingling: Numbness or tingling sensations in the affected area may also occur with TOS.
• Weakness: Weakness in the affected arm may occur due to nerve compression caused by TOS.
• Blood clots: Compression of the subclavian vein (the main vein in your arm) can cause clotting that can lead to pulmonary embolism (a potentially life-threatening condition).
• Damage to nerves and blood vessels: The prolonged compression that results from thoracic outlet syndrome may permanently harm blood vessels and nerves if left untreated.

• Perform Abhyanga, a traditional ayurvedic massage, to improve circulation and reduce tension in the thoracic area.
• Use heat therapy such as hot compresses to relax the same muscles.
• Take ashwagandha to reduce pain and inflammation in the area, as well as strengthen the body's natural immunity.
• Eat ginger frequently as it helps block inflammation pathways and relieve pain and stiffness associated with TOS
• Practice yoga postures like shoulder stand or bridge pose can provide relief from the syndrome through gentle pressure on certain nerves.

• The effects of thoracic outlet syndrome can be lessened by consuming an appropriate amount of fresh fruits and vegetables, whole grains, and lean proteins.
• When you have thoracic outlet syndrome, eating healthy fats like avocados, nuts, and olive oil can help minimise the swelling that comes with it.
• Consuming foods that are rich in antioxidants such as blueberries, tomatoes, and green tea can help to reduce inflammation and may even help to prevent further damage to the nerves and muscles in the thoracic outlet region.
• Eating a diet low in sodium can help to reduce fluid retention which may be causing symptoms of thoracic outlet syndrome.

• High Fat Foods: Avoid high-fat foods like fried foods, red meat, butter. These can increase inflammation in the thoracic outlet region and aggravate symptoms.
• Salty Foods: Eating foods high in sodium (salt) can cause fluid retention and make it harder for the body to process toxins. The signs and symptoms of Thoracic Outlet Syndrome may become even more severe as a result of this.
• Caffeine: While small amounts of caffeine may be tolerated, larger amounts can cause headaches and put increased pressure on the nerves and veins within the thoracic outlet area.
• Spicy Foods: Chili peppers and other spicy ingredients have been shown to disrupt nerve endings in the thoracic outlet, increasing pain levels associated with Thoracic Outlet Syndrome.
• Dairy Products: Dairy products like milk products, cheese, yoghurt and ice cream may produce congestion or irritation of the affected areas making squeezing or compression of nerves or blood vessels worse, increasing pain levels associated with Thoracic Outlet Syndrome.

• First Rib Resection: The first rib, which is the rib nearest to the collarbone, is surgically removed during this treatment. Because of this, the pressure on the nerves and blood vessels in the thoracic outlet may be relieved, which in turn may help to reduce the symptoms of thoracic outlet syndrome.
• Subclavian Artery and Vein Transposition: This procedure involves surgically moving the subclavian artery and vein away from the thoracic outlet in order to reduce pressure on them. This can help relieve symptoms of thoracic outlet syndrome and prevent further complications such as blood clots or stroke.
• Thoracic Outlet Decompression Surgery: This is a more invasive procedure that involves removing part of the rib, collarbone, or muscles in order to create more space for the nerves and vessels in the thoracic outlet.
• Scalenectomy Surgery: This procedure involves removing one or two scalene muscles located at either side of the neck in order to reduce pressure on nerves and vessels that pass through them. This type of surgery is often done as part of a larger treatment plan for thoracic outlet syndrome.

Consult a competent medical professional who specialises in the diagnosis and treatment of thoracic outlet syndrome to get their opinion.

A primary care physician (PCP) may be able to provide advice or suggest further options for the patient.

A neurologist, orthopaedic surgeon, vascular surgeon, physiatrist (rehabilitation medicine doctor), pulmonologist (lung doctor), or cardiothoracic surgeon may also be able to help diagnose and treat TOS.

• Non-steroidal Anti-inflammatory Drugs (NSAIDs): These are analgesic/anti-inflammatory medications such as ibuprofen, naproxen and acetaminophen, which can help reduce the symptoms of thoracic outlet syndrome such as pain and swelling.
• Analgesics: Medications such as codeine, hydrocodone, and oxycodone are examples of these types of drugs that help alleviate pain.
• Muscle Relaxants: Medications such as baclofen or tizanidine that can help relax the muscles in the thoracic outlet region can be useful for easing any tension in the thoracic outlet area due to repetitive use or strain from activities like sports or strength training.
• Antidepressants: Medications such as amitriptyline or fluoxetine, have been known to have very good results when used long term for relieving some of the symptoms associated with thoracic outlet syndrome, especially if combined with physical therapy and other measures of treatment.
• Corticosteroids: Oral or injection steroids may be recommended when an upper extremity neuropathy resulting from thoracic outlet syndrome has caused numbness and weakness in any of your limbs resulting from compression of a nerve in your cervical spine.

The length of time it takes to recover from Thoracic Outlet Syndrome is dependent not only on the severity of the ailment but also on the method of treatment that the affected individual chooses.

In most cases, recuperation might take anything from a few weeks to many months to complete.

The vast majority of therapies do not produce outcomes that are long-lasting.

Depending on the type of treatment, some results may last longer than others, but most treatments will require repeated applications or maintenance to maintain their effects.

• After treatment for Thoracic Outlet Syndrome (TOS), it is important to follow a regular post-treatment regime in order to avoid reinjury or relapse.
• This includes physical therapy, stretching exercises, and lifestyle modifications such as avoiding activities that risk aggravating the symptoms of TOS.
• It is also important to pay attention to posture and ergonomics when sitting, standing, and working.
• Additionally, patients should notify their healthcare provider if they experience any pain or other symptoms related to the condition after treatment has been completed.

Treatments for Thoracic Outlet Syndrome in India might range in price significantly based on the severity of the ailment as well as the treatment modality that is selected.

Generally, the cost of surgery can range from around Rs. 70,000 to Rs. 2,50,000 or more.

Non-surgical treatments such as physical therapy and medications may also be prescribed to help manage symptoms which may cost around Rs. 5,000 to Rs. 15,000.

• Discomfort and sensitivity in the region that was treated as a result of the therapy.
• Numbness, tingling, or a burning feeling in the arms or hands.
• Swelling at the site of treatment.
• Changes in blood pressure.
• Damage to nearby nerves or blood vessels.
• Muscle weakness in the shoulder area.
• Difficulty breathing and swallowing due to nerve damage.
• Infection at the site of treatments.

If you have any issues from Thoracic Outlet Syndrome, you should see a doctor right away since they may cause 'blood clots, nerve and blood vessel damage,' and treatment duration can vary from a few months to years depending on the extent of the condition.