CINN Medical Group Physician Blog

Thoracic Outlet Syndrome

Recently in my office I treated a patient who presented with numbness in the fingers, occasionally in the forearm leading up to the elbow, and weakness in the affected hand, especially when gripping. This was all right sided. The patient worked on a computer during the day and was a musician, playing electric bass guitar at night. He had a history of past shoulder problems, with an unremarkable MRI taken several years earlier and a recent cervical MRI which was also unremarkable, showing no neural or foraminal compromise. Carpal tunnel was ruled out via standard orthopedic testing during examination and history. He had been given Celebrex by his primary care physician and had received no conclusive diagnosis after examination by a variety of practitioners.

The thoracic outlet is a space between the collarbone and 1st rib where nerves from the brachial plexus and blood vessels that travel into the arm pass. Compression of these nerves or blood vessels can cause symptoms which include numbness or tingling in the neck, shoulder, arm or fingers, pain or ache in arm or shoulders, weak grip, difficulty with fine motor tasks, as well as circulatory issues such as coldness, discoloration, or swelling in the hand.

The first task for the practitioner is to rule out other pathology which may mimic this condition, such as carpal tunnel, tendonitis, or herniated disc in the cervical spine. Once diagnosed through exam, orthopedic tests, and appropriate imaging, conservative treatment includes joint manipulation or mobilization, physical therapy modalities, stretching of the scalene muscles, prevention includes home stretching instructions, postural review and correction, and correction or discontinuation of any repetitive activities which may have been the cause of the problem. If an anatomical defect such as a cervical rib or pathology such as a Pancoast tumor are the cause they will be identified by imaging. In the case of a cervical rib the solution will usually lie with surgery.