Neurogenic thoracic outlet syndrome (neurogenic TOS) occurs when the nerve between the collar bone and the first rib (the top rib) is compressed. The thoracic outlet is the small opening just below the collarbone that allows the blood vessels and nerves to serve the arms. Neurogenic TOS involves the brachial plexus, the nerve that controls the movement and feeling of the shoulders, arms, and hands. Neurogenic TOS accounts for 95% of TOS cases. The remaining 5% are vascular TOS.
Symptoms may include numbness or tingling in the arms or fingers and achy or shooting pains in the neck, shoulders, or hands. It is also possible to have a weakening grip and experience Gilliatt-Sumner hand – where the muscles at the base of the thumb waste away (atrophy). Headaches in the back of the head are common. Arms may feel tired if raised over the head to do work.
Neurogenic TOS is most often caused by neck trauma (whiplash), injury due to slipping or falling on floors or ice, or stress from repeated movements at work in assembly lines or keyboard use. All of these events may cause scar tissue in the neck muscles which may cause neurogenic TOS.
The syndrome may be difficult to diagnose because symptoms vary greatly and are similar to the symptoms of other conditions. Diagnosis will include provocation tests in which you are asked to move in certain ways to see if symptoms appear. Your doctor will look for tenderness in certain places in your neck, chest, or arms. To confirm the diagnosis, your doctor may use imaging tests including X-rays, CT scans, and MRIs, as well as a nerve conduction test. Treatments for TOS include physical therapy, medications, or surgery. If you or a family member has been diagnosed with vascular TOS, talk to your doctor and specialist(s) about the most current treatment options. Support groups are a good source of information and can help connect you with others affected by TOS.