Thoracic outlet syndrome: How is it treated?

Thoracic outlet syndrome is a rare nerve and circulatory condition. Treatment depends on the underlying cause and the severity of the signs and symptoms.

Your thoracic outlet is the small space between your collarbone (clavicle) and your first rib. Many nerves, muscles and blood vessels to the arm pass through this opening. Thoracic outlet syndrome occurs when this space narrows, compressing the nerves and blood vessels. Although thoracic outlet syndrome typically affects both sides of the body, the problem is often worse on one side.

In many cases, the cause of thoracic outlet syndrome can't be determined. It may be present at birth (congenital) or occur as the result of injury or repetitive activities. You may be at increased risk of this condition if you have:

• A long neck and drooping shoulders
• Abnormalities of the muscles in the neck or of the first rib
• An extra rib (cervical rib)
• Prior injuries to the muscles or bones in this area

Thoracic outlet syndrome may first appear in some women during pregnancy. Signs and symptoms of thoracic outlet syndrome include:

• Numbness in the last three fingers and inner forearm
• Bluish discoloration of the hand and arm
• Swelling in the arm
• Pain in the neck and shoulders
• Weakness and wasting of muscles in the hands
• Rarely, tiny black or blue spots or ulcers on the pads of the fingers

Treatment of thoracic outlet syndrome may include:

• Pain relievers, such as ibuprofen and acetaminophen
• Physical therapy to strengthen shoulder muscles
• Surgery to relieve compression, such as by removing part or all of an extra rib or the first rib
• Surgery to repair compressed blood vessels