Thoracic Outlet Syndrome

The thoracic outlet is an anatomical region of the body, which runs from the neck and under the clavicle towards the upper limb. The boundaries of the thoracic outlet change over this course and at different levels include combinations of muscle, tendon, fascia and bone. Everybody has a thoracic outlet on each side of their body and as long as there is adequate space, then people are able to function well without symptoms. 

Thoracic outlet syndrome is a disorder where the amount of space in this region is insufficient, and as a result of this, there is pressure upon either the nerves or blood vessels or both. The pressure on the nerves and blood vessels causes these structures to not function properly which causes symptoms. Symptoms can vary but the most common symptoms of thoracic outlet syndrome are pain around the shoulder, neck and scapula (shoulder blade), combined with abnormal tingling and numbness on one side of the hand and forearm. There can also be colour changes of the arm. These symptoms are typically positional and conspicuously worse when the affected limb is elevated. 

There are different types of thoracic outlet syndrome, depending on whether the nerves or artery or vein are most affected, although a combination is common. Thoracic outlet syndrome can be difficult to diagnose at times. It is ultimately a diagnosis made by the history and the examination findings which may be supported by various tests including Xray, ultrasound and MRI. 

Patients can present with thoracic outlet syndrome early in life if they have a congenital anatomical issue such as a cervical rib or an anomalous band of fascia causing pressure during growth and development. By contrast, post traumatic thoracic outlet syndrome arises in patients who have never had any problems until they sustained a major trauma to the neck or shoulder or head, at which time the thoracic outlet becomes compromised.

The initial treatment of thoracic outlet syndrome is most commonly physical therapy by a dedicated hand therapist or physiotherapist. Happily many patients improve over time with non surgical treatment. Surgery is a major undertaking with significant risks which must be accepted. If a patient fails nonsurgical treatment, or if a patient has a profound mechanical problem in their thoracic outlet, then they are likely to be offered surgery in order to maximise the chance of improving their symptoms. 

A/Prof Ferris sees a large number of patients with thoracic outlet syndrome and is able to see you with an appropriate referral to evaluate you and progress your care as is required.

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