Thoracic outlet syndrome (TOS) is a group of disorders characterized by the compression or injury of the blood vessels or nerves in the thoracic outlet, which is the space between the lower neck and upper chest. This commonly causes neck, shoulder and arm pain; numbness in the fingers, hands and arms; and impaired circulation to the upper extremities. TOS can affect people of any age, but it is more common in young adults between the ages of 20 and 40.
There are a few types of TOS. Vasculogenic TOS occurs when one or more of the veins or arteries under the clavicle become compressed, injured or otherwise irritated. The most common type of TOS, neurogenic TOS, occurs due to a compression of the brachial plexus, or the network of nerves that provides motor and sensory function to the upper extremities.
Internationally recognized for his expertise in brachial plexus surgery, Dr. Jason Ko is highly sought-after to treat neurogenic TOS. The gifted plastic and reconstructive surgeon diagnoses TOS quickly and accurately, and offers innovative treatment solutions to relieve pain and restore normal or near-to-normal function.
What Causes TOS?
Neurogenic TOS, which accounts for approximately 95 percent of all cases of TOS, may occur due to congenital abnormalities of the bony and soft tissue in the lower neck region (e.g., a cervical rib) that reduce space for and put pressure on the nerves of the brachial plexus.
Other cases of neurogenic TOS develop from repetitive motions of the arms or shoulders (e.g., typing or assembly line work) that enlarge the tissue around the thoracic outlet. Neurogenic TOS is also common in athletes who play sports that require repetitive arm and shoulder movements (particularly those who swim or play baseball or volleyball). Whiplash and similar injuries from motor vehicle accidents are to blame for some cases of neurogenic TOS.
If you experience pain or numbness in your neck, shoulders, arms or hands, you should see Dr. Ko for an evaluation. He will take your complete medical history and perform a physical examination to check for any external signs of TOS, such as swelling or discoloration in your arm, or limited range of motion. The two of you will discuss the symptoms you are experiencing, and Dr. Ko may order tests such as MRIs, electromyography (EMGs) or ultrasounds to confirm or rule out thoracic outlet syndrome.
Treating TOS
Sometimes TOS can be managed with conservative approaches such as anti-inflammatory or pain medications or physical therapy. Exercises to strengthen and stretch the shoulder muscles may relieve symptoms and improve range of motion.
Cases of TOS that have not resolved with non-operative care require surgery. Fellowship-trained in microvascular surgery and one of the world’s leading experts on brachial plexus injuries, Dr. Ko receives many referrals to treat complex cases of neurogenic TOS. The objective of TOS surgery is to remove the source of compression on the brachial plexus. Depending on the case, TOS decompression will involve removing abnormal muscles and fibrous bands that are compressing the nerves of the brachial plexus. Rarely, Dr. Ko will have to remove the first rib, if necessary. After learning more about the circumstances of your case and determining that surgery will benefit you, Dr. Ko can recommend the most appropriate solution.
For more information about the diagnosis and treatment of neurogenic thoracic outlet syndrome, please contact the practice of Dr. Jason Ko today.