Thoracic Outlet Compression

What is thoracic outlet?

Thoracic outlet is the narrow space that is crossed by veins and nerves when they leave the trunk toward the arms. This region lies between the clavicle and the first rib and can be palpated in the base of the neck.

What is thoracic outlet compression?

In some people, the thoracic outlet is narrower than the usual. This may cause compression in the blood vessels and the nerves.  The thoracic outlet may be narrowed by:

  • Alterations in the posture
  • An additional rib in the neck (cervical rib)
  • Alterations in the muscles
  • A previous fracture that develop a callus

Many people are born with these alterations. Other people acquire the alterations during life. Thoracic outlet compression is also named thoracic outlet syndrome.

What are the symptoms of thoracic outlet compression?

The symptoms of thoracic outlet compression depend on which structure is under compression. If the problem is in the nerves, people feel pain, weakness and numbness in the arm. If the problem is in the blood vessels, the arm may become painful, swollen, with red or blue color. These symptoms occur when the arms are elevated.

What are the risks of thoracic outlet compression?

If the compression is maintained for long time, the nerves can be permanently damaged, causing pain and weakness in the arms. The blood vessels can be also harmed and a thrombosis or an aneurysm may appear.

Is there a test for thoracic outlet compression?

The vascular surgeon can diagnose thoracic outlet compression with careful neck palpation with the arms upwards. In order to confirm the diagnosis, get details of each case, and plan the treatment, he may need imaging exams:

  • Neck and thorax X-rays – important to detect an additional rib in the neck or other anatomical alterations.
  • Duplex ultrasound – visualizes the blood vessels and say if there is compression.
  • Computed tomography – uses X-ray to visualize the thoracic outlet and diagnose the compression in detail. Requires an injection of a chemical in the arm vein, that makes the vessels show up more clearly.
  • Magnetic resonance imaging – uses a magnet to visualize the thoracic outlet. Can bring precise details. It also requires an injection of a chemical in the arm vein.
  • Angiography - uses X-ray and a chemical injected directly in the blood vessels. Important in the most severe cases.

What is the treatment of thoracic outlet compression?

The treatment of thoracic outlet compression aims to improve symptoms and avoid complications. The vascular surgeon may recommend:

  • Medicines – are used to relieve symptoms. Generally, analgesics, anti-inflammatory and muscle relaxants are prescribed.
  • Adequate posture – Daily activities must be adapted to a new posture that relieves the thoracic outlet compression. Work routine must also be evaluated and adapted.
  • Physical therapy – Exercises and other measures help posture adaptation and may reduce the thoracic outlet compression. The results often can be felt after three month of treatment.
  • Surgery – The vascular surgeon can do a surgery to remove the cause of compression. Routinely, the additional rib, the first rib and the muscles that cause the compression are removed. This procedure is done with a cut in the neck or in the axilla, always under general anesthesia. Surgery may be considered when the other forms of treatment did not work. When the blood vessels are involved, surgery is generally the fist option.
What is the best treatment?

The best treatment depends on each case. The best treatment for one case may not be the most appropriate for the other case. The choice will depend:

  • If the compression is on the nerves or on the blood vessels
  • On the intensity of symptoms
  • On the degree of compression
  • On age, profession, sport activities, personal habits of each patient.