Whether it’s from dealing with too much stress during the week or taking on too many weekend chores, feeling tightness and pain in your arms and hands is not uncommon and can come from a variety of sources.
If your symptoms persist, you may have an often overlooked and underdiagnosed condition known as thoracic outlet syndrome. It’s caused when neck muscles next to the collarbone pinch the nearby artery, vein or nerves against the first rib. There’s very little space for these vital structures to pass through.
In the most simple cases, the syndrome can lead to chronic pain and numbness, while in severe cases, it can cause large — and potentially life-threatening — blood clots that lead to swelling and need to be addressed immediately.
[See: 7 Signs You Should Stop Exercising Immediately.]
Finding the Source
Pain from thoracic outlet syndrome can be severe and last for years. While about one-third of patients can recover with physical therapy, most others will likely require surgery. The trick to knowing which treatment will work best is getting the correct diagnosis.
Because arm pain can have so many causes, physicians must rule out a variety of ailments before considering thoracic outlet syndrome. Similar pain can come from a compressed disc in the neck, arthritis or a neck injury, among other conditions. Once those are ruled out, the next step is to consider that the problem is coming from thoracic outlet syndrome.
While many cases of thoracic outlet syndrome result from trauma, like car accidents, often it’s due to the way the body is built, muscle growth and repetitive activity. The condition commonly afflicts athletes who train with repeated, overhead motions of their arms — such as tennis or volleyball players, baseball pitchers and swimmers.
In fact, because children are specializing at such an early age in sports and other activities these days, at The Ohio State University Wexner Medical Center we’ve treated patients as young as 12. Children often train year-round, several times a week, in activities like gymnastics, cheerleading and swimming, which can lead to overuse injuries and the development of thoracic outlet syndrome.
But it’s not just athletes. It can also affect those whose everyday jobs require them to extend their arms in a repetitive action. Painters and builders are often susceptible, as are those who sit at desks doing computer work. Spending hours a day typing at a computer with your arms resting inappropriately is a common cause of thoracic outlet syndrome.
As physicians, we look for the condition presenting in one of three ways. The most common is numbness and tingling in the arms, or sometimes weakness, resulting from compressed nerves.
The second most common symptom is swelling, which indicates vascular blockage. In some cases, patients see their arm swell to as much as twice its normal size and become discolored. That’s a sign that clots are blocking the subclavian vein, a large vein at the top of the chest.
The third category of patients suffer from arm fatigue and discoloration extending the length of the arm, which indicates a clot in the subclavian artery. In these cases, however, small pieces of the blood clots can break loose and travel to the fingers. Without prompt and appropriate treatment, patients run the risk of losing fingers due to limited blood circulation.
[See: 5 Physical Therapy Procedures You Should Question.]
Releasing the Pain
Because of the dangers they pose, safely clearing blood clots is our priority. Once they’ve been successfully addressed, we give the patient time to recover and then tackle the source of the problem, the compression of the vein or artery against the first rib.
In people whose nerves are compressed, we prescribe physical therapy to try to strengthen the shoulder and improve posture. If pain persists and is debilitating, the next step is surgery.
During an operation, I’ll enter through the armpit or occasionally above the clavicle, on my way to the first rib. Comprehensive knowledge of the anatomy and meticulous technique are mandatory in excising the first rib, which is in close contact with large arteries, veins and critical bundles of nerves that must not be injured. I remove the front two-thirds or more of the rib to create space for the compressed nerve, vein and artery.
In many cases, the effect is almost instantaneous. The ensuing decompression of these large structures reduces pressure and relieves pain. After a couple months of healing, patients can go back to their normal activities, including competitive sports.
Many people with thoracic outlet syndrome resign themselves to simply putting up with the pain. But with the right diagnosis and timely treatment, they’re able to get back to leading a normal life.
For more on the condition, check out our comprehensive thoracic outlet syndrome information center on the Ohio State University Wexner Medical Center website.
[See: Exercising After You’ve Gone Under (the Knife, That Is).]
Dr. Patrick Vaccaro is director of vascular diseases and surgery at The Ohio State University Wexner Medical Center.
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Is Thoracic Outlet Syndrome Causing Your Chronic Arm Pain? originally appeared on usnews.com
