Thoracic outlet syndrome is the name given to a rather controversial diagnosis involving neurological symptoms thought to originate in the nerves of the brachial plexus. This condition is on the rise in the neck pain sector, with more diagnosed cases being recommended to long-term or even surgical treatment year after year. Like many neck pain syndromes, the possibility for misdiagnosis with brachial plexus pain is quite high, so diagnosed patients are always strongly advised to learn all they can about the condition before agreeing to any ongoing or invasive therapy option.
This resource section explains the diagnosis of thoracic outlet syndrome, including neurogenic, arterial and venous varieties.
Thoracic Outlet Syndrome Facts
The brachial plexus is a neurological super-center consisting of nerve roots branching off from the vertebrae at C5, C6, C7, C8 and T1. These nerves provide most of the innervation for movement and feeling in the muscles of the lower neck, upper back, shoulders and arms. There are 2 main varieties of diagnosed TOS pain:
Neurogenic thoracic outlet, also called neurological thoracic outlet, involves suspected compression of the actual nerve roots either in the spinal column or after they leave the spine. The cause can be due to herniated discs, arthritis and virtually any compressive spinal issue, or may be muscular in the case of post-spinal column impingement. In almost all cases, the diagnosis of TOS applies to nonspinal compression syndromes involving muscular involvement.
Arterial thoracic outlet or venous thoracic outlet involve compression of major blood vessels in the same region, usually by some spasming soft tissue, such as a muscle. The two most commonly affected vascular structures include the subclavian artery and the subclavian vein.
Thoracic Outlet Symptoms
The symptoms of thoracic outlet are typical for many varieties of neck pain, particularly for the neurogenic varieties. The patient may suffer neck pain, neck tingling, weakness in the neck, shoulders or arms and possible numbness in the neck, shoulders and/or arms.
If a spinal causation is found to be responsible, the diagnosis will rarely be made as thoracic outlet, although I have seen it as such on occasional MRI reports. If no structural issues are found to be responsible, then further testing of the muscles will usually result in the TOS diagnosis if they are found to be potentially compressing sensitive nerve or vascular structures within the brachial plexus.
Thoracic Outlet Interventions
Due to the great number of possible conditions which may be called TOS, patients are often confused when they read information which does not apply to them or only partially applies. I can certainly sympathize with this, as I had this experience throughout my own back and neck pain story. However, do not blame the informational sources. Instead, blame the doctors. They are the ones who make the diagnosis of TOS, despite a huge difference in the reasons and circumstances of the individual patient complaints and causative processes.
In our experience, the diagnosis of nonspinal thoracic outlet pain turns out to be a complete waste of time for the patient in many cases, since regional ischemia is likely the root causation and not some theorized and often ridiculous muscular compression speculation. The generally ineffective nature of most treatment supports this statistic 100%. In other cases, compression is truly occurring, but this may also be linked to ischemia, or less commonly, purely anatomical issues.