Thoracic outlet syndrome (TOS) is a group of signs and symptoms that happen when the vein, artery, or nerves that supply your arm and hand are squeezed (compressed). To reach your arm, all of these have to pass through a tight space under your collarbone and above your top rib (thoracic outlet).
There are three types of TOS:
• Compression of the nerves that supply your arm and hand is called neurogenic TOS. Most people with TOS have this type.
• Compression of the vein that returns blood from your arm and hand (subclavian vein) is called venous TOS.
• Compression of the artery that carries blood to your arm and hand (subclavian artery) is called arterial TOS. Arterial TOS is the rarest type.
Depending on which structures are affected, you may have symptoms on one side or both sides of your body.
• Neurogenic TOS may be caused by swelling or scarring in your neck muscles that results in the narrowing of your thoracic outlet. This leads to nerve compression. It can happen from:
○ Neck injuries from an auto accident (whiplash).
○ Repetitive stress on your neck from working with your arms. This stress could be from using a keyboard all day or working on an assembly line.
• Venous TOS may be caused by doing hard work with your arms, especially if you have to lift your arms above your head. A blood clot may form in the vein.
• Arterial TOS may be caused by having an extra rib at the base of your neck (cervical rib). This rib presses on your subclavian artery. Over time, this pressure may cause a clot to form inside the artery, or the artery may weaken and balloon outward (aneurysm).
• You may be at greater risk for neurogenic TOS after a neck i...
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...t a height where your hands are slightly lower than your elbows. Slide your chair under your desk so that you are close enough to maintain good posture.
When lying down and resting, avoid positions that are most painful for you.
• If you have pain with activities such as sitting, bending, stooping, or squatting (flexion-based activities), lie in a position in which your body does not bend very much. For example, avoid curling into a fetal position on your side.
• If you have pain with activities such as standing for a long time or reaching with your arms, (extension-based activities), lie with your spine in a neutral position, and bend your knees slightly. Try the following positions:
○ Lying on your side with a pillow between your knees.
○ Lying on your back with a pillow under your knees.
ExitCare® Patient Information ©2012 ExitCare, LLC.
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