Doctor insights on:
Thoracic Outlet Syndrome Pain
Nerve symptoms: Tos caused by nerve ; artery impingement as pass through costoclavicular dimension between clavicle (collar bone) ; top first rib; space about one centimeter in life. When joints ; muscles of shoulder girdle injured, space prematurely closes with arm raising. Nerve symptoms are tingling ; numbness pinky side of hand ; forearm. Artery symptoms of hand coolness ; ischemia. Nerve symptoms dramatic. ...Read moreSee 1 more doctor answer
Crowding: Pressure on brachial plexus the nerves from the spinal cord to arm become a group of nerves called the brachial plexus it is compressed by a crowding from an extra rib on top of the rib cage 1st rib or extra cervical rib the working theory goes adfitionally vascular compression of brachial artery or vein can produce arm symptoms nerve pain can extend proximal to neck or distal to arm and hand. ...Read moreSee 1 more doctor answer
TOS: Tos involves the lower portion of the brachial plexus, where nerves from the neck pass through a tunnel into the chest on the way to the arm. The plexus can get trapped in the outlet area, and this event can cause pain, numbness, tingling, weakness, but can also affect blood vessels. On occasion, a congenital first rib can cause compression but trauma may also promote tos. ...Read moreSee 1 more doctor answer
Narrowing of space: Thoracic outlet syndrome is narrowng of the space between the first rib and the anterior scalene muscle. The axillary vein and artery and brachial plexus nerve passes through this space. Narowing the space can pinch the artery, vein, nerve or all of the above. Also, a rare, abnormal cervical rib can cause the same problems. ...Read moreSee 2 more doctor answers
Not necessarily.: Assuming that is correct diagnosis, this can commonly be helped with physical therapy. There may be necessity to consider surgical intervention for refractory symptoms, yet that surgery is commonly successful. This is a difficult diagnosis, to come to, so I would make sure you are comfortable with how you came to this diagnosis, and if not consider another opinion. ...Read moreSee 1 more doctor answer
Different areas: Wrist carpal tunnel- median nerve pinched. Thoracic outlet: first rib, clavicle and muscles tight on vein, artery and nerves both cause neuropathic symptoms:numbness, pain, weakness etc carpal does not usually have any blood vessel symptoms/ clots. ...Read moreSee 2 more doctor answers
Muscle imbalances: Imo tos results from superior trapezius (st) weak & collar bone droops toward first rib closing costoclavicular space (between these bones) clipping artery & nerves to arm. Weak st conscripts neighbor levator scapulae (ls) to burden lifting scapula (sc) & 20 lb. Arm. Long & narrow, ls incurs chronic spasm, tendonitis at insertion on superior sc spine (pick-like), & snapping as shoulder rotates. ...Read more
1st rib fx & TOS: Trauamtic 1st rib fractures can contribute to TOS especially when there is a non-union (fracture pieces do not heal back together as one unit. Pieces press on vessels & nerves). Hemorrhage from the fracture into the thoracic outlet can also contribute to TOS (compression of vessels & nerves by blood). ...Read more
Quite often: Several centers of expertise thruout the usa now exist with surgeons possessing great experience. Success rates are approaching 80-85 % in carefully selected cases, whose preoperative testing is definitive. Excellent outcomes can be found at ucla, johns hopkins, washington univ. In st louis, and psl in denver, co. ...Read moreSee 1 more doctor answer
Can thoracic outlet syndrome or any other brachial plexus issues cause scapular instability/winging?
Winged Scapula: A "winged scapula" is a result of injury to the long thoracic nerve which innervates the serratus anterior muscle. The long thoracic nerve is made up of portions of the brachial plexus, namely cervical roots 5, 6, 7, so in theory, a brachial plexus injury can cause a winged scapula but it is unlikely to be in isolation of other nerve problems. Winged scapula is not typical in thoracic outlet. ...Read moreSee 1 more doctor answer
Related: The thoracic outlet contains both a collection of nerves like the brachial plexus and blood vessels serving the arms. Any compromise of the to can cause symptoms affecting both the nerves and circulation by compression of either or both causing similar sensations of cold, numbness and tingling. Simple exercises such as wall push-ups can sometimes yield some relief. See a physical therapist or dr. ...Read moreSee 4 more doctor answers
Brachial plexus : Tos is caused by compression of usually the lower brachial plexus at the level of the medial cord. A congenital cervical rib may be present but trauma can also cause the problem. Pain and numbness especially on elevation of the arm is characteristic, but the subclavian artery or vein may be involved. Thus, both neurogenic and vascular problems separate or together. ...Read more
Unlikely: Thoracic outlet affects lateral neck, shoulder blade, lateral upper chest, and radiates down the arm typically to digits 4 and 5 of the hand, if the neurogenic variety. A more distal variation seems focalized to the lateral chest and armpit, (pectoralis minor). T-6 is too low for tos. Severe pain there is more likely of discogenic origin, if within the spine, or referred pain from internal organs. ...Read more
Not very common: Three manisfestations: 1. Pinching of the artery leading to the arm and hand (most common) 2. Pinching of the vein leading to the arm and hand, resulting in swelling (next common) 3. Pinching of the nerve resulting in various types of pain (not very common). ...Read moreSee 1 more doctor answer
If scapular instability is the cause of thoracic outlet syndrome, would rib resection/scalenectomy resolve neck & scapula pain?
More complex: Thoracic outlet syndrome surgery includes, often, first rib resection and/or scalenectomy, but there are different surgical approaches and also, pectoralis minor decompressions. Scapular instability may or may not be present, and this may represent problems in the upper brachial plexus. Since this is so individualized and particular in most cases, best to discuss with experienced vascular surg. ...Read more
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