Symptoms & Causes

Neurogenic Thoracic Outlet Syndrome

Chronic compression of the nerves may lead to discomfort in the affected arm including:

• Numbness and tingling in the fingertips or hand.
• Shooting or burning pain down the arm.
• Weakness in the hand or arm.

These symptoms are frequently worsened when the arm is in the overhead position (which narrows the thoracic outlet) or with dangling the arm (which stretches the brachial plexus). There are certain patient populations at risk for developing NTOS:

• Athletes whose activity includes repetitive overhead motion, such as baseball and softball players, weightlifters, and gymnasts.
• Workers whose professions require repetitive elevation of the arms or overhead activity such as landscapers, laborers, and hair stylists.
• Patients who spend a large amount of time working on the computer, watching television, or playing video games with poor posture or workplace ergonomics.
• Patients who have cervical ribs or other cervical spine transverse process abnormalities.

 

Venous Thoracic Outlet Syndrome

There are two possible presentations of VTOS:

• Sudden swelling of the arm due to an acute deep venous thrombosis (DVT) of the axillosubclavian vein, otherwise known as Paget-Schroetter Syndrome.
• Chronic arm swelling and discomfort with activity due to chronic injury and narrowing of the subclavian vein without an acute DVT.

 

Arterial Thoracic Outlet Syndrome

There are several different scenarios in which patients with ATOS may present:

• Sudden pain or numbness and tingling in the fingertips or hand due to acute clots that have traveled to the arteries of the fingers, hand, and/or forearm.
• Chronic, crampy pain and fatigue associated with exercise due to restriction of flow through the narrowed subclavian artery.
• A pulsatile mass discovered on physical exam.
• Incidental discovery at the time of thoracic outlet decompression for NTOS.