What is Arterial Thoracic Outlet Syndrome (TOS)
Arterial thoracic outlet syndrome is a condition that happens when the artery that carries blood to your arm and hand (subclavian artery) is squeezed (compressed).
To reach your arm, the artery must pass through a tight space under your collarbone (clavicle) and above your top rib (thoracic outlet). There are different types of TOS, and this type is the rarest.
Depending on which structures are affected, you may have symptoms on one or both sides of your body.
What are the causes?
This condition may be caused by having an extra rib at the base of your neck (cervical rib). This rib presses on your subclavian artery. Over time, this pressure may cause a clot to form inside the artery, or the artery may weaken and balloon outward (aneurysm).
What increases the risk?
The following factors may make you more likely to develop this condition:
- Having been born with a cervical rib.
- Being overweight.
- Having poor posture.
What are the signs or symptoms?
Symptoms of this condition include:
- Pain and cramps in your arm or hand.
- Pale skin or a change in color of the skin on your hand and arm.
- Very cold hands.
- In rare cases, some people may have muscle loss in their hands.
These signs and symptoms may be worse when you hold your arms over your head.
How is this diagnosed?
Your health care provider may suspect TOS from your symptoms. A physical exam will be done. During the exam, your health care provider may ask you to hold your arms over your head and in other positions to check whether your symptoms get worse. Tests may also be done to confirm the diagnosis and to find out what is causing TOS. These may include:
- Imaging
studies, such as:
- X-rays to look for a cervical rib or other abnormality of the ribs.
- A test using sound waves to create an image (ultrasound).
- CT scan.
- MRI.
- A test that involves measuring and recording the pulses in your wrists (pulse volume recording).
- A test in which X-rays are done after dye is injected into your subclavian artery or vein (venogram orangiogram).
How is this treated?
This condition may be treated with surgery to:
- Remove the cervical rib.
- Remove a blood clot (thrombus).
- Repair an aneurysm.
Treatment may also include:
- A procedure to open up the clotted vein and restore blood flow (angioplasty).
- Medicine, including blood thinners or blood clot dissolvers.
Follow these instructions at home:
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Do stretching exercises as told by your health care provider or physical therapist.
- Maintain good posture.
- Do notcarry heavy bags over your shoulder or repetitively lift heavy objects over your head.
- Take frequent breaks to stretch and rest your arms if you work at a keyboard or do other repetitive work with your hands and arms.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You have pain, cramps, numbness, or tingling in your arm or hand.
- Your arm or hand often feels tired.
- Your arm turns a darker and different skin color than usual.
- Your hand feels cold.
- You have frequent headaches or neck pain.
- You have muscle loss in your hand.
Get help right away if:
- You lose feeling in your arm or hand.
- You cannot move your fingers.
- Your fingers turn a dark color.
Summary
- Arterial thoracic outlet syndrome (TOS) is a condition that happens when the artery that carries blood to your arm and hand (subclavian artery) is squeezed (compressed).
- This condition may be caused by having an extra rib at the base of your neck (cervical rib). This rib presses on your subclavian artery.
- Symptoms of this condition include pain and cramps in your arm or hand, pale skin or change in color of the skin on your hand and arm, very cold hands, and muscle loss in your hands.
- This condition may be treated with surgery, angioplasty, and medicines.
