Understanding Thoracic Outlet Syndrome

Understanding Thoracic Outlet Syndrome

Have you ever experienced pain, numbness, or a "pins and needles" sensation in your arms, hands, or fingers? Or perhaps you’ve noticed your hand feeling unusually cold or discolored? These could be signs of Thoracic Outlet Syndrome (TOS), a condition that occurs when the blood vessels or nerves in the thoracic outlet (the space between your collarbone and first rib) become compressed. This compression can affect the subclavian artery, subclavian vein, or the brachial plexus (a network of nerves that controls movement and sensation in the arm and hand).

Thoracic Outlet Syndrome can be caused by multiple factors including but not limited to physical trauma, repetitive strain, or even poor posture. If left untreated, it can lead to chronic pain, weakness, and even loss of function in the affected arm. But don’t worry, understanding the condition and taking proactive steps can help you manage or even prevent it.

Check out this great educational video on Thoracic Outlet Syndrome: Video Source: Mass General Brigham

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What Are the signs of Thoracic Outlet Syndrome? 

How do you know if Thoracic Outlet Syndrome is causing your discomfort? Here are some common symptoms to watch for:

• Pain in the arm, hand, or fingers:
  Pain may radiate from the shoulder down to the fingers, often affecting the inner side of the arm.

• Numbness or tingling:
  A "pins and needles" sensation, especially in the fingers or hand, is a common symptom.

• Weakness in the arm or hand:
  You may notice a decrease in grip strength or difficulty performing tasks that require fine motor skills.

• Coldness or discolouration in the hand:
  In severe cases, reduced blood flow can cause the affected hand to feel cold or appear pale or bluish.

• Pain in the neck, shoulders, or upper back:
  Discomfort may also be felt in the trapezius, rhomboid, or pectoral muscles.

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What causes Thoracic Outlet Syndrome?

Understanding the causes of Thoracic Outlet Syndrome can help you identify risk factors and take preventive measures. Here’s what might be contributing to your symptoms:

• Traumatic Injury: 
  Any physical trauma, such as a car accident or a fall, can lead to fractures of the rib or collarbone (clavicle). These injuries can narrow the thoracic outlet passageway, compressing the blood vessels and nerves within it. Even if no fracture occurs, the trauma can cause swelling or scar tissue that contributes to compression.
  

• Repetitive Trauma Due to Sports or Activities:
  Repetitive overhead movements or strain on the shoulders and arms can irritate the nerves and blood vessels in the thoracic outlet. This is particularly common in:

1. Sports: Activities like tennis, swimming, and baseball require repetitive arm and shoulder movements, which can lead to overuse injuries. 
2. Weightlifting: Lifting heavy weights, especially with poor form, can strain the muscles and structures in the thoracic outlet.
3. Work-related tasks: Jobs that involve repetitive overhead motions or prolonged use of the arms (e.g., painting, construction, or assembly line work) can also contribute to Thoracic Outlet Syndrome.
   

• Swelling in the thoracic outlet: 
  Swelling caused by tumors, enlarged lymph nodes, or other growths in the lower neck or upper chest region can compress the thoracic outlet. This compression can affect the nerves and blood vessels, leading to symptoms of Thoracic Outlet Syndrome.
  

• Congenital Defects
  Some people are born with anatomical abnormalities that increase their risk of developing Thoracic Outlet Syndrome such as:

1. Extra rib (cervical rib): Approximately 0.2% to 0.5% of the population is born with an extra rib at the base of the neck. This additional rib can narrow the thoracic outlet, compressing the nerves and blood vessels.
2. Abnormal muscle or ligament structure: Tight or abnormally positioned muscles or ligaments can also contribute to compression.
   

• Gender and Age Factors:
  Thoracic Outlet Syndrome is more common in females than males. Additionally, most cases occur in individuals between the ages of 20 and 50.

• Poor Posture and Lifestyle Factors:
  Sitting or standing with rounded shoulders and a forward head position can narrow the thoracic outlet, increasing pressure on the nerves and blood vessels. This is becoming increasingly more common due to factors such as computers and phone usage.

• Prolonged overreaching
  Tasks that require you to reach forward or overhead for extended periods (e.g., using a computer mouse or working on an assembly line) can strain the thoracic outlet.

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How to prevent or reduce symptoms

If you’re experiencing symptoms of Thoracic Outlet Syndrome or want to reduce your risk, here are some practical steps you can take:

 

• Repetitive Trauma Due to Sports or Activities:
  Repetitive trauma from sports or certain activities is a common cause of Thoracic Outlet Syndrome. Movements that involve frequent overhead use or strain on the shoulders and arms such as tennis serving, overhead weightlifting, or even repetitive tasks like painting, can irritate the nerves and blood vessels in the thoracic outlet.

  If you’re beginning to feel discomfort in these areas, it’s important to adjust your activities. This might mean limiting or modifying repetitive motions, switching arms when possible, or using tools designed to reduce strain. Small changes can help prevent further irritation and protect your shoulders and arms from ongoing stress.

• Avoid Repetitive overreaching:
  Reducing overreaching motions of your arm being outstretched and if possible move your body closer.

• Limit overhead movements:
  Try to minimise activities that require prolonged or repetitive overhead arm movements.  Using tools such as stools or ladders you can prevent lifting over your head, its not always possible in work settings but try to lower the weight if you must do overhead movements and always keep a correct lifting posture.

Incorporate Stretches and Exercises

• Stretch your neck and shoulders:
  Rehab Science on Youtube has some great exercises you can look into but it is recommended to check first with a healthcare professional. Gentle stretches can help relieve tension and improve flexibility in the thoracic outlet area.

• Strengthen your muscles:
  Focus on exercises that strengthen the muscles in your shoulders, upper back, and chest to support proper posture and reduce compression.

Improve Your Posture

• Sit and stand up straight:
  Bad posture can compress your nerves and blood vessels in the thoracic outlet so its time to start to regularly check your posture to make sure your sitting and standing with your shoulders kept back and your head aligned with the spine.  Avoid slouching or rounding your shoulders forward. Bad posture can be very hard to break bad habits but is something you'll need to proactively remind yourself till it becomes normal habit.  If your work environment involves a lot of sitting start looking into ergonomic chairs or sit or stand desks.
  

• Adjust your workspace:
  Ensure your desk, chair, and computer are set up to promote good posture. Your elbows should be at a 90-degree angle, and your wrists should remain straight and not bent up reaching to a keyboard.

• Compact Keyboards:
  You might not think a smaller keyboard could make a big difference with Thoracic Outlet Syndrome, but it actually helps a lot by reducing shoulder abduction, with your arms and shoulders kept closer to your body, there's less outward reach and that all means less compression on the thoracic outlet.

  Using a compact keyboard also encourages a more neutral posture. When your elbows stay relaxed and close to your sides, it helps reduce tension in the scalene (Neck muscles) and pectoral muscles (Chest muscles) both commonly linked to Thoracic Outlet Syndrome symptoms.

  As the name suggests, compact keyboards are smaller than standard ones, often skipping the number pad. This brings your hands, wrists, and mouse into a more centered position, supporting better upper body alignment. It also minimises overreaching for the mouse, which on its own is a common contributor to Thoracic Outlet Syndrome.

• Ergonomic Vertical Mice:
  Just like the compact keyboard switching up your mouse to an ergonomic vertical mouse can make a huge difference to your daily computing.  A vertical mouse encourages a more natural handshake position (picture your hand on a desk in the position of giving an handshake).  This handshake position reduces the internal rotation of the shoulders and the tension through the forearm all which play key roles in reducing and preventing Thoracic Outlet Syndrome. 

With the more neutral wrist and arm alignment plays straight into reducing pressure on scalene (neck) and pectoral (chest) muscles that can be in constant compression against the thoracic outlet with tradition mice alongside of bad posture.

Promoting Neutral Wrist and Arm Positions

Traditional keyboards and mice often force your wrists into awkward positions, such as excessive extension or pronation (twisting of the forearm). This can compress nerves and blood vessels, worsening Thoracic Outlet Syndrome symptoms. 

• Split Keyboards:
  These keyboards are divided into two halves, allowing your hands to rest in a more natural, shoulder-width position. This alone allows your arms and shoulders to rest more comfortably at your side instead of angling inward.  This helps reduce should internal rotations and abduction both of which can compress the Thoracic outlet.  With the split keyboard offering more relaxed positioning of typing and better body posture it helps take the tension of the scalene and pectoral muscles which tradition flat keyboards can make overactive or become tight.

• Tented Keyboards:
  Some ergonomic keyboards can be tilted or "tented" to keep your wrists in a neutral, handshake-like position. Everything from the Split Keyboards apply to the Tented Keyboards but now we are on a higher angle helping keep forearm pronation and wrist strain down while helping keep your upper body posture better.