Thoracic Outlet Syndrome

This condition, which is more common in women and causes pain, numbness or easy fatigue in both upper extremities (arms), is primarily caused by compression of the arteries, veins and nerves that run to the arms at the upper opening of the thoracic cage (thoracic outlet). Patients often go back and forth between neurology, orthopedics and physical therapy without finding a definitive solution to their complaints, and are often unhappy. Patients' complaints are neurovascular findings caused by compression of the vessels and nerves between the clavicle, the first rib and the scalene muscles (most commonly with a cervical rib as the cause); they manifest as rapid arm fatigue, pain, numbness, tingling and even coldness when hanging laundry or writing, or when carrying heavy bags or objects.

The most important finding in diagnosis is a good physical examination and history, although radiology and EMG are helpful in guiding treatment. In treatment, priority is given to symptomatic medical treatment, and surgical treatment should be considered in those who do not benefit from it. Once the causative factor has been definitively identified, surgical treatment takes the form of scalene myotomy, cervical rib or first rib resection, etc.