Thoracic outlet syndrome (TOS) represents a broad spectrum of clinical issues that result from compression of blood vessels and nerves exiting the chest and neck area and going into the arm. Thoracic outlet space is a narrow space between the collar bone and first rib and has three scalene muscles in that space. Through this space the subclavian vein, artery and brachial plexus pass and either of these structures can get compressed to give rise to venous, arterial or neurogenic thoracic outlet syndrome.
In the venous TOS, patients present with sudden onset of arm swelling and pain and ultrasound will show clot in the subclavian vein. Arterial TOS presents with diminished blood flow to the arm and hand and sometimes with painful tips of fingers from thrombus emboli, and ultrasound can elicit compression and irregularity of the subclavian artery. Neurogenic TOS is most complex of all and can present with varied symptoms, including neck pain, arm pain, headaches, tingling numbness in arm and hand, sharp pain starting in the collar bone area and radiating to the arm that gets worse with repetitive activities. Dr. Sidhu at VIVAA can evaluate and diagnose all three kinds of TOS.
He will then discuss the treatment options depending upon the nature of the TOS. For venous TOS, Dr. Sidhu will use clot-busting medication to dissolve the clot first and then decompress the thoracic outlet space by removing part of the first rib and freeing up the muscles. For arterial TOS, the thoracic outlet space is decompressed and sometimes the subclavian artery will need reconstruction to restore flow to the arm. For neurogenic TOS, Dr. Sidhu will work very closely with your physiatrist to rule out any neck or shoulder issues, because the symptoms from neck and shoulder problems can mimic neurogenic TOS. The initial management for neurogenic TOS involves specific physical therapy.
During the same period, depending upon the symptoms, there could be a need for MRI of the neck and brachial plexus, nerve conduction studies and even scalene muscle block. If the conservative management fails, then surgical decompression of the thoracic outlet space is recommended along with freeing up of the nerve bundle. Dr. Sidhu at VIVAA can coordinate and manage the complex nature of TOS.
When you need comprehensive care for thoracic outlet syndrome, come to Vein, Vascular & Aesthetic Associates. We serve the communities of Serving the communities of Everett, Issaquah, Kirkland, Newcastle, Seattle and Sammamish.
When you need vascular and endovascular procedures or vascular ultrasound, choose the double board-certified surgeon at Vein, Vascular & Aesthetic Services. For more information or to make an appointment, call us today at 425-250-9999. For your convenience, you can use our online Request an Appointment form.