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.
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.
Nerve and vascular. Nerves connecting the arm and the spinal cord pass into the chest through a tunnel termed the thoracic outlet. In close contact are blood vessels. The tunnel can become too narrow and compress the nerves and/or blood vessels, with attendant pain, numbness, weakness, tingling, change in arm color, and especial problems if the arm is elevated.
Shoulder Pain. Thoracic outlet syndrome (tos) manifests as chromic shoulder pain, frequent episodes of arm going "to sleep" at night while reclined, and tingling and crawling sensations radiating into the arm, often into the pinky side of the hand. the traditional explanation is that nerves and arteries going from the neck spine and from the core (thorax) of the body are pinched by tight scalene muscles, which.
Usually yes. Yes, usully with surgery in severe symptomatic cases.
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.
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.
Impressions. First, make certain that you do indeed have neurogenic TOS (proven by EMG study of brachial plexus), or vascular TOS (proven on arteriographic surveys). Feldenkreis PT can reverse about 85% of cases, and experience surgeons have well over 93% positive outcomes. Nearest expertise to you at Johns Hopkins.
Surgery. Thoracic outlet surgery is done to remove pressure or compression of the nerve, artery, and vein going to the arm. This involves removing the first rib, and releasing any scar tissue present. This results in significant reduction in symptoms in most cases.
No specific test. Unfortunately, there is no specific "thoracic outlet syndrome test". There are a number of things that may lead your physician to consider this diagnosis, but quite frankly the diagnosis is often overlooked. Symptoms are pain above your collarbone or in the affected arm, but the process can also affect the vein and artery to the arm. Studies of the arteries and veins can confirm the diagnosis.
EMG and Ultrasound. A few new approaches to diagnose tos are available now. Ultrasound imaging may demonstrate the narrowing than compresses nerves and blood vessels. New EMG techniques can show abnormal nerve function over the thoracic outlet. Angiographic imaging of blood vessels can display the local compressions.
Pain, numbness. Thoracic outlet syndrome can affect the vein, artery or nerves of the arms. Symptoms can include swelling of the arms, (vein compression) pain or numbness when using the arms overhead, or pain that can extend from the neck or shoulder down to the hands or fingers. Most symptoms are aggravated by doing things that narrow the space where vein, atery and nerve travelling to the arm are.
Thoracic outlet. This is from compression of brachial plexus from first rib first try physical therapy before first rib removal if diagnosis has been confirmed.
Yes. Physical therapy is the mainstay of treatment and sometimes surgery is necessary.
Yes. There are three major types. The most common is related to pain and nerve compression. This one responds to physical therapy sometimes. The other two types may involve the artery or vein. These are less common. The treatment can be a bit controversial, espescially the nerve compression type. See a surgeon experienced in thoracic outlet disease such as a vascular or cardiothoracic surgeon.