NEURALGIA AND NERVE DISORDERS: CAUSES OF THORACIC OUTLET SYNDROME

More than 80 percent of the patients with thoracic outlet syndrome (TOS) have a history of some type of trauma (a car accident, for example) before they experience symptoms. Traumatic events obviously can cause immediate changes to the bony or soft tissue structures forming the thoracic outlet.

Some people may have an abnormality present since birth, such as an extra (or cervical) rib or more subtle changes — called insidious — to the bony or soft tissue structures that make up the borders of the thoracic outlet. Insidious onset of TOS usually is caused by poor posture or maintaining a certain position for long periods of time. Insidious onset of TOS also may be the result of repetitive or consistent overhead movements.

Signs and Symptoms of Thoracic Outlet Syndrome

The signs and symptoms an individual may experience depend on whether the nerves are compressed or the artery or veins are compressed.

Symptoms of arterial or venous compression from TOS are swelling in the arm, discoloration and/or temperature change in the hand, and a deep ache or pain in neck, shoulder and/or arm. The arm may tire easily and feel heavy.

Symptoms of nerve compression from TOS include altered sensation in the arm (called parathesia), numbness and tingling in any area from the neck to the hand, muscle weakness and wasting (atrophy) in the arm, and sharp pain in the arm and hand.

Getting Help for TOS

While TOS can be a chronic, sometimes debilitating condition, a variety of treatments are available to help alleviate the symptoms. The important thing is to find a health care provider who understands pain management. Shop around and get multiple consultations, if needed, until you are completely satisfied that the doctor or facility can help you manage your TOS. Here are some questions to ask your physician:

· How many cases of TOS have you treated?

· What are your special qualifications to treat patients with TOS?

· What is your approach to TOS pain and symptom management in terms of medications, injections and complementary therapies?

· What types of medications do you generally prescribe?

· What types of non-medication therapies do you use?

· Where do you refer patients who need additional treatment?

· Is your clinic listed with any professional societies? (You can check this out yourself by visiting the professional groups listed below.)

· Do you have seven-days-a-week, 24-hour coverage if I need help?

Here are some places and people that may be able to help manage TOS pain:

· Comprehensive Pain Center. Such centers provide multi-modality (several different types of treatment), interdisciplinary treatment. Make sure that the center has expertise in treating patients with TOS.

· Thoracic Surgeons. Thoracic surgeons manage TOS but not all have special expertise or interest in treating TOS.

· Physical Medicine and Rehabilitation Specialists. Also called physiatrists, these doctors may be medical doctors (MDs) or osteopaths (DOs).

· Physical Therapists. Some physical therapists have special knowledge and treatment skills for TOS.

· Pain Medicine Physician. Pain medicine has become a medical specialty in recent years. Pain medicine physicians specialize in treating many different pain conditions and are expert in knowing how and when to use the many different treatments available. Depending on background and interest, many treat TOS; however, inquire about their experience and interest in treating TOS and whether they incorporate a variety of therapeutic (multi-modality) approaches.