For the past few months, I’ve been waking up with a feeling of numbness in my arms. It was bothering me so much that I mentioned it to my GP who thinks it might be something called thoracic outlet syndrome. Can you explain what this is?
Thoracic outlet syndrome (TOS) is a condition where symptoms are caused by the compression of nerves or blood vessels, or both, because of an inadequate passageway through an area called the thoracic outlet, which lies between the base of the neck and the armpit. The thoracic outlet is surrounded by muscle, bone and other tissues. Any condition that results in enlargement or movement of the tissues of or near the thoracic outlet can cause the thoracic outlet syndrome.
Symptoms can include neck, shoulder and arm pain, numbness or impaired circulation to the extremities. Symptoms may be reproduced when the arm is positioned above the shoulder or extended.
TOS can cause a wide spectrum of symptoms from mild and intermittent, to severe and constant. Pains can extend to the fingers and hands, causing weakness. Diagnosis of thoracic outlet syndrome is suggested by the symptoms and physical findings, and is sometimes supported by electrical and/or radiology tests.
Can it be treated?
Thoracic outlet syndrome often responds to conservative measures. These can include a range of exercises that effectively stretch the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a “relaxed” open position. Physiotherapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their intervention can be helpful.
Exercise programmes can then be done at home or at work to relax the muscles around the thoracic outlet. Those with TOS should avoid prolonged positions with their arms held out or overhead. It is best not to sleep with the arm extended up behind the head and to avoid sleeping on the stomach with arms above the head.
It is also helpful to have rest periods at work to minimise fatigue and refrain from repetitively lifting heavy objects or weights. Weight reduction can be helpful for those who are overweight.
Those with severe, resistant symptoms may require surgical operations to open the thoracic outlet. These procedures include removal of the first rib in order to spare injury to the affected nerve and blood vessels from ongoing compression.
