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Thoracic outlet syndrome (TOS) is the general term used to describe a condition caused when the nerves and blood vessels below your neck (between the collarbone and the first rib) are compressed. Types of thoracic outlet syndrome include:
Work activities involving prolonged restricted postures such as carrying heavy shoulder loads, pulling shoulders back and down, or reaching above shoulder level can cause the inflammation and swelling of tendons and muscles in the shoulders and upper arms. When swollen or inflamed, they can compress the nerves and blood vessels between the neck and shoulders. Weak shoulder muscles, long necks and sloped shoulders, poor posture and obesity may contribute to thoracic outlet syndrome. Repetitive injuries from sports related activities can also be a cause of this syndrome. Examples of occupations that are at risk of this syndrome can include dental hygienists, typing on a computer, working on an assembly line, or lifting items above your head.
The cause of the compression can vary, but include:
Slightly more women than men may develop this syndrome. It is more common in young adults, between 20 and 40 years old.
Depending on which structures are compressed, symptoms can vary. When nerves are compressed, symptoms of neurological thoracic outlet syndrome can include:
Signs and symptoms of vascular thoracic outlet syndrome can include:
The diagnosis is made by medical history and physical examination. Special laboratory tests can confirm the diagnosis.
The initial treatment of patients with thoracic outlet syndrome consists primarily of a carefully planned program of exercise therapy. Avoidance of work activities suspected of causing the condition may be necessary. Physicians may prescribe anti-inflammatory drugs to reduce the pain and inflammation. In some cases surgery may be necessary if symptoms persist for a long time.
The prevention of thoracic outlet syndrome should focus on the design or redesign of the workplace so that workers will avoid carrying heavy weights, reaching overhead, and lifting with the arms above shoulder level. Routine conditioning to strengthen muscles and improve posture can reduce pressure on nerves and blood vessels.
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