Thoracic Outlet Syndrome

WHAT YOU SHOULD KNOW:

  • Thoracic outlet syndrome (TOS) is a condition that occurs when nerves or blood vessels are compressed (pinched) in the thoracic outlet. The thoracic outlet is the area between your collarbone and your first (top) rib. Nerves and blood vessels run through the thoracic outlet as they go from your chest out to your hands. TOS may occur on one or both sides of your body. TOS may be caused by an injury, a congenital problem, drooping shoulders, or repeated movements. You may have pain, numbness, tingling, and swelling. You may have a weak grip or weak hand muscles and your hand may get smaller.

  • TOS is diagnosed with a health history and physical exam. Your caregiver will check your symptoms and may order more tests. Treatment depends on the kind of TOS you have. Treatment may include pain medicines and physical therapy. It may also include medicines to prevent or treat blood clots, or surgery. Treatment can help relieve symptoms and improve the use of your arm or hand.

AFTER YOU LEAVE:

Medicines:

  • Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.

  • Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.

  • Nonsteroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your primary healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow the directions on it before using this medicine.

  • Blood thinners: This medicine helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.

Ask your caregiver when to return for a follow-up visit:

If you had surgery, you may need to see your caregiver to have any drains or stitches removed. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Activity:

After surgery, you may have limited movement of your arm for 3 to 4 weeks. Ask your caregiver when it is okay to return to your normal daily activities. You may be able to return to sports after surgery. Ask your caregiver when you can start playing sports again.

Managing your thoracic outlet syndrome:

  • Rest and elevate. If you have vascular TOS, your caregiver may tell you to rest and elevate (raise) your arm. When you are sitting or lying down, prop your arm on 2 to 3 pillows. This will raise your arm above the level of your heart and decrease swelling.

  • Avoid activities that make your symptoms worse. Do not sleep with your arms above your head. Avoid activities that involve repeated overhead movements.

Physical therapy:

  • A physical therapist helps you with special exercises. These exercises help strengthen the muscles in your neck, shoulders, and back. This can help increase the amount of room in the thoracic outlet. These exercises can also help improve your posture.

  • If you have surgery, caregivers will give you stretching and strengthening exercises to do afterward. Exercises may help increase how much you can move your arm and hand. Certain exercises can help prevent swelling and may help prevent your TOS from returning. Caregivers may suggest that you start your prescribed exercises the day after surgery. Keep doing these exercises for as long as your caregiver suggests. Ask your caregiver for more information on the exercises you should do after surgery.

Caring for your wound after surgery:

  • You may have a bandage for 1 to 2 days. You may have a pressure bandage to decrease swelling. You may need to use an arm sling for a while after surgery. Ask your caregiver how long to wear the sling.

  • Scar tissue can form after surgery. This can put more pressure on the thoracic outlet and you may continue to feel pain. Caregivers will teach you how to prevent scar growth. They may show you how to use a scar pad and apply ice. Caregivers may also suggest massage to decrease or prevent scar buildup. Ask your caregiver for more information about preventing scar growth.

For support and more information:

It can be hard to cope with the chronic pain of TOS. You may feel frustrated and sad. These feelings are normal. It may help to learn all you can about TOS. Ask your caregiver for more information. You can also contact the following:

  • National Institutes of Health
    9000 Rockville Pike
    Bethesda , MD 20892
    Phone: 1- 301 - 496-4000
    Web Address: www.nih.gov

CONTACT A CAREGIVER IF:

  • You have pain, numbness, or tingling in your head, neck, shoulder, arm, or hand.

  • You have a weak grip.

  • One hand looks smaller than the other.

  • The movement of your arm is still limited four weeks after surgery.

SEEK CARE IMMEDIATELY IF:

  • Your arm, hand, or both ache or feel heavy.

  • Your arm, hand, or both feel cold, look pale, or have a bluish color.

  • Your arm feels warm, tender, and painful. It may look swollen and red.

  • You have chest pain or trouble breathing that is getting worse over time.

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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