It’s a condition that causes pain, numbness, and tingling in the shoulder and arms. We’re talking about thoracic outlet syndrome, or TOS, and relieving the pain might mean removing body parts.


For Kami Bathon, staying active is a way of life.  “I was an extremely active person my entire life. I was a dancer and a soccer player,” Kami said.   However, a year ago, this fitness enthusiast developed severe pain and numbness in her arm that severely limited her workouts.

“It would feel like something was tearing through my bicep. I went from being able to deadlift 250 pounds, to where I couldn’t pick up my purse from the car seat next to me,” Kami explained.

Kami had Neurogenic Thoracic Outlet Syndrome, or TOS. The nerves in her neck and shoulder were being compressed by bones and other tissues.  To relieve the pain, surgeon Robert Thompson first removed muscles in front of the nerves and cleared away scar tissue. Then, he removed muscles behind the nerves and took out a rib. Finally, he divided the pectoralis muscle.


“That gives the most thorough decompression of the nerves,” Robert W. Thompson, MD, Professor of Surgery (Vascular Surgery), Radiology, Cell Biology and Physiology; Director, Center for Thoracic Outlet Syndrome; Department of Surgery, Washington University School of Medicine, told us.

Now, months after her surgery, Kami is feeling much better and she has a souvenir.
“They removed my first rib from the right side during surgery,” Kami said.  Now, she can focus on her workouts and not her pain.


Dr.  Thompson says removing the first rib and some of the surrounding muscles will not cause any harm to the patients, as they can function without them. He says TOS is more common in athletes like baseball pitchers, who use repetitive arm motions.

BACKGROUND: Thoracic outlet syndrome (TOS) is a group of disorders that occur when nerves or blood vessels become compressed between the collarbone and the first rib (thoracic outlet). This may cause pain in the shoulders and neck and numbness in your fingers.  Causes of TOS include physical trauma from a car accident, repetivie injuries from job or sports-related activities, pregnancy, and certain anatomical defects (like having an extra rib).  If a vein happens to become compressed, the arm may become swollen and will be sensitive to the cold. This is more common in women between ages 20-50. (Source: http://www.mayoclinic.com/health/thoracic-outlet-syndrome/DS00800 and http://www.nlm.nih.gov/medlineplus/thoracicoutletsyndrome.html)

TYPES: There are three types of TOS:

  • Vascular thoracic outlet syndrome: This type occurs when one or more of the veins or arteries under the collarbone (clavicle) are compressed.
  • Neurogenic (neurological) thoracic outlet syndrome:  This form of TOS is characterized by compression of the brachial plexus, a network of nerves that come from the spinal cord and control muscle movements and sensation in the should, hand, and arm.
  • Nonspecific-type thoracic outlet syndrome: This type is also called disputed thoracic outlet syndrome. Some doctors don't believe it exists, while others say it's a common disorder. People with this form of TOS have chronic pain in the area of the thoracic outlet that worsens with activity. (Source: http://www.mayoclinic.com/health/thoracic-outlet-syndrome/DS00800/DSECTION=symptoms)

TREATMENT: In some cases, physical therapy can be the best form of treatment for thoracic outlet syndrome patients. This therapy will strengthen the shoulder muscles to enhance the range of motion. Physical therapy may also help your posture and take the pressure off of your nerves and blood vessels. Minimally invasive surgery can help certain patients with neurogenic thoracic outlet syndrome. In a study published in Journal of Vascular Surgery, researchers studied 200 patients who were referred to the hospital for disabling neurogenic thoracic outlet syndrome from February 2008 to October 2011. Fifty-seven patients underwent pectoralis minor tenotomy (PMT). The remaining 143 patients had supraclavicular decompression combined with PMT (SCD+PMT).  In both groups, the most common symptoms were pain in the arms, neck, and shoulders, as well as pain, weakness, and paresthesia of the hands. After surgery, 163 of the 200 patients (82%) reported significant and progressive improvement at the 3-month follow-up, including 43 of the patients who underwent isolated PMT (75%) and 120 who underwent the combined procedure (84%). (Source: http://www.medscape.com/viewarticle/779191)

 

FOR MORE INFORMATION, PLEASE CONTACT:

 

Robert W. Thompson, MD

Professor of Surgery (Vascular Surgery), Radiology, Cell Biology, and Physiology

Director, Center for Thoracic Outlet Syndrome

Department of Surgery, Washington University School of Medicine

(314) 362-7410

thompson@wudosis.wustl.edu

www.tos.wustl.edu