THORACIC OUTLET SYNDROME (TOS): SHOULDER AND NECK PAIN CAN BE SIGN OF TOS. CALIFORNIA ATTORNEY CAN HELP.March 27, 2008
Thoracic Outlet Syndrome (TOS) is marked by pain and other symptoms in the upper region of the body (from your head to your chest). Motor vehicle accident trauma and repetitive motion sustained in a work setting are frequent causes of TOS. Shoulder and neck pain, as well as hand numbness are common signs.
TOS Definition: Thoracic Outlet Syndrome is a group of disorders which cause often painful symptoms in the head, neck, shoulders, arms, hands and chest. These symptoms are the result of compression of nerves and blood vessels in your thoracic outlet region (the space between your collarbone and your armpit or first rib). Symptoms of TOS usually include pain in the neck and shoulder area and numbness and weakness in arms, hands and/or fingers. There are several classifications of thoracic outlet syndrome, depending on the cause. Neurogenic (neurological) thoracic outlet syndrome is the most common form.
Thoracic Outlet Syndrome Causes:
The central cause of TOS is the compression of structures (nerves, blood vessels) in the thoracic outlet (area under your collar bone). Causes of this compression include:
- Trauma, to the shoulders or neck, such as a car accident. Symptoms of TOS after a trauma may not be present right away.
- Repetitive Activity: Work which includes heavy lifting, lifting repeatedly over your head, typing for extended periods of time, laboring on an assembly line or sitting at your computer for long periods without proper support. Swimmers, baseball players and instrumental musicians are at high risk due to the repetitive nature of their professions.
- Joint pressure, as a result of carrying an overweight backpack, and from obesity
- Bad posture, including holding your head forward or drooping shoulders
- Pregnancy: As joints loosen during pregnancy, the first signs of thoracic outlet syndrome could appear during this time.
- Congenital defects: Inherited problems present at birth.
Thoracic outlet syndrome symptoms will vary, depending on which nerves or blood vessels are compressed. The most frequent symptoms include:
- Shoulder and Neck Pain
- Arm or Hand Ache
- Numbness and/or Tingling of Arms, Hands and/or Fingers
- Heaviness in the upper extremities
- Weakening Grip or Clumsiness
- Dizziness or lightheadedness
Less common symptoms include:
- Arm pain and swelling
- Lack of color in hand or fingers
- Discoloration of hand
- Small black spots on fingers
- Ear pain
- Throbbing bulge near collarbone
If you are consistently experiencing these symptoms, see your doctor.
Diagnosis of Thoracic Outlet Syndrome:
As a result of the many symptoms of TOS, diagnosis can be difficult. As a result, many experience frustration and stress after suffering for years before they are diagnosed. Seeking a second opinion can be helpful in acquiring a diagnosis for persistent symptoms.
At your examination, your doctor will first look for physical signs of TOS including discoloration in your arms or hands, a limited range of motion in your upper body, or a shallow dent in your shoulders. Then your doctor may ask you perform tests designed to replicate your symptoms, called “provocation tests.” Here are some tests that are used:
Roos Stress Test: Holding your elbows at shoulder height and repeatedly opening and closing your hands, while holding back your shoulders. Your doctor will note any resulting symptoms
Adson’s Maneuver: turning the head towards your ailing shoulder with an outstretched arm. While inhaling, your doctor checks your pulse.
Wright Test: Holding up and rotating your arm, while your doctor checks your pulse.
Selmonosky Triad: Elevating of the hands to evaluate tenderness and/or weakness in the 4th and 5th fingers.
Your doctor may order other tests to aid in diagnosis. An X-ray, MRI (magnetic resonance imaging scans), EMG (electromyography), or Nerve Conduction Study may be required.
Untreated Thoracic Outlet Syndrome can cause permanent nerve damage. Treatment is designed to control and minimize pain, while improving quality of life. Surgery is sometimes considered for TOS, but usually as a last resort. Here are more conservative treatment approaches, which can be most effective with early diagnosis:
- Physical Therapy: To strengthen muscles and improve both posture and range of motion.
- Stretching: Certain back and shoulder exercise can relieve the nerve compression causing TOS. Follow the instructions of your practitioner.
- Relaxation: Deep breathing and other relaxation techniques help with tense neck, back and shoulders.
- Posture correction: Correct breathing, adjusted chairs, braces or even improved shoes can assist in maintaining better posture.
- Medication: Prescription pain killers, muscles relaxers and anti-inflammatories can help with overall muscle relaxation. Cortisone or Botox are also used in TOS treatment.
When the above treatments are ineffective, your doctor might recommend surgery which normally involves reparation of blood vessels, or possible tissue removal.
If you are in California, and you believe that you or a loved one is suffering from Thoracic Outlet Syndrome due to the negligence of another or an accident, please contact us. Call the Law Offices of The Rudman Law Firm, APC LLP toll-free at 1-800-ALAWPRO (1-800-252-9776). Speak to an experienced personal injury lawyer who knows your rights. All consultations are free and confidential.