Thoracic Outlet Syndrome Information Page
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What is Thoracic Outlet
Is there any
What is the
is being done?
What is Thoracic Outlet
Thoracic outlet syndrome (TOS) consists of a group of distinct
disorders that affect the nerves in the brachial plexus (nerves that pass into
the arms from the neck) and various nerves and blood vessels between the base of
the neck and axilla (armpit). For the most part, these disorders have very
little in common except the site of occurrence. The disorders are complex,
somewhat confusing, and poorly defined, each with various signs and symptoms of
the upper limb.
True neurologic TOS is the only type with a clear definition that
most scientists agree upon. The disorder is rare, typically painless, and caused
by congenital anomalies (unusual anatomic features present at birth). It
generally occurs in middle-aged women and almost always on one side of the body.
Symptoms include weakness and wasting of hand muscles, and numbness in the
Disputed TOS, also called common or non-specific TOS, is a highly
controversial disorder. Some doctors do not believe it exists while others say
it is very common. Because of this controversy, the disorder is referred to as
"disputed TOS." Many scientists believe disputed TOS is caused by injury to the
nerves in the brachial plexus. The most prominent symptom of the disorder is
pain. Other symptoms include weakness and fatigue.
Arterial TOS occurs on one side of the body. It affects patients of
both genders and at any age but often occurs in young people. Like true
neurologic TOS, arterial TOS is rare and is caused by a congenital anomaly.
Symptoms can include sensitivity to cold in the hands and fingers, numbness or
pain in the fingers, and finger ulcers (sores) or severe limb ischemia
(inadequate blood circulation).
Venous TOS is also a rare disorder that affects men and women
equally. The exact cause of this type of TOS is unknown. It often develops
suddenly, frequently following unusual, prolonged limb exertion.
Traumatic TOS may be caused by traumatic or repetitive activities
such as a motor vehicle accident or hyperextension injury (for example, after a
person overextends an arm during exercise or while reaching for an object). Pain
is the most common symptom of this TOS, and often occurs with tenderness.
Paresthesias (an abnormal burning or prickling sensation generally felt in the
hands, arms, legs, or feet), sensory loss, and weakness also occur. Certain body
postures may exacerbate symptoms of the disorder.
Is there any
Treatment for individuals with TOS varies depending on the
type. True neurologic TOS is generally effectively treated with surgery. Most
other forms need only symptomatic treatment. Common or disputed TOS requires
conservative treatment which may include drugs such as analgesics, and physical
therapy to increase range of motion of the neck and shoulders, strengthen
muscles, and induce better posture. Some cases of disputed TOS may require
surgery (although, like the diagnosis, surgery is controversial). Heat,
analgesics, and shoulder exercises have been used with limited success in
individuals with traumatic TOS. Surgery may be needed in some cases. Vascular
TOS often requires surgery.
What is the prognosis?
prognosis for individuals with TOS varies according to the type. For the
majority of individuals who receive treatment the prognosis for recovery is
What research is being
Within the NINDS research programs, TOS is addressed through
research on pain. NINDS vigorously pursues a research program seeking new
treatments for pain and nerve damage with the ultimate goal of reversing
disorders such as TOS.
Select this link to view a list of studies currently seeking
American Chronic Pain Association (ACPA)
P.O. Box 850
National Rehabilitation Information Center (NARIC)
Lanham, MD 20706-4829
National Chronic Pain Outreach Association (NCPOA)
P.O. Box 274
Millboro, VA 24460
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