Definition:

The thoracic outlet is defined as the area between the back of the neck and the chest on top of the first rib.  It allows passage of various structures, including the trachea, esophagus, nerves, and blood vessels.  These nerves and blood vessels supply the area around the chest, the arms, and the lungs.  Thoracic outlet syndrome can occur when there is an extra rib on top of the first rib that presses upon these structures.  This rib can either be bone or cartilaginous.  Other causes include poor posture and other physical abnormalities.

Symptoms:

• Pain and/or tingling in the following areas
  • Neck
  • Shoulder
  • Arm
• Weakness in muscles of the hand
• Different from angina in that thoracic outlet syndrome pain does NOT occur while walking, while angina does

Diagnosis:

• Arm lifting above shoulders leads to discoloration of arm due to compressed blood vessels
• X-Ray - may see the "extra rib"
• MRI - may see a fibrous band above the rib cage
• Electromyography - electrical testing to see nerve conduction between arm and brainstem

Treatment:

• Physical therapy - strengthen muscles
• Surgery - to remove extra rib or fibrous band