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Symptoms of Thoracic Outlet Syndrome 

Signs and symptoms of Thoracic Outlet Syndrome vary with every patient according to the location of injury, irritation and/or compression within the thoracic outlet.  Symptoms of Thoracic Outlet Syndrome can range from mild pain and numbness to life and limb threatening complications. Patients can present with multiple signs and symptoms associated with involvement of both neurogenic and vascular components.  Symptoms can be unilateral or bilateral.

Common Symptoms of Thoracic Outlet Syndrome include but are not limited to:

Upper Extremity

  • Numbness and tingling of the arm and hand
  • Positional weakness of the arm and hand
  • Swelling of the arm and/or hand 
  • Heaviness of the upper extremity
  • Ulnar distribution paresthesias
  • Weakness or clumsiness of the hand
  • Cool or cold extremity and/or hand
  • Tiredness, heaviness and paresthesias with arm elevated
  • Color changes of the hand and/or arm (cyanotic, pale, mottled)
  • Venous Distention of Upper Extremity

Head, Neck, Chest and Shoulder

  • Neck pain
  • Shoulder pain (can mimic rotator cuff injury pain)
  • Inter-para scapular pain
  • Anginal Chest pain
  • Unexplained headaches
  • Funny or odd feelings in face and/or ear (some patients have reported a tight pulling and tingling feeling)
  • Dizziness, lightheadedness
  • Vertigo, syncope
  • Diplopia, Dysarthria, Dysphonia, Dysphagia
  • Tinnitus, ear pain
  • Color, swelling and temperature changes to the upper neck and/or chest

Color and/or temperature changes can indicate serious vascular complications and can be life and limb threatening.
Swelling can indicate serious vascular complications and can be life and limb threatening.

A Neglected Cause of Dizziness and Neck Pain
BMJ Dr Carlos Selmonosky- Thoracic Outlet Syndrome (TOS) causes dizziness because of positional compression of the vertebral artery with resultant symptoms of vertebrobasilary insufficiency. Compression of C7,C8,and T1 nerves fibers is responsible for the neck pain. The diagnosis of TOS should be performed in all patients complaining of dizziness and or neck pain; because TOS may be partially or totally responsible for the symptoms attributed to another pathology. The clinical diagnosis of TOS is made by the use of a Diagnostic Triad in the physical examination: 1) weakness of abduction and adduction of the fifth finger(C8, T1). 2) Tiredness, paresthesias of the upper extremity on elevation of the hands pointing to the ceiling. Associated or not with paleness of the hands; extreme paleness is called the White Hand Sign. 3) tenderness on thumb pressure in the supraclavicular area.(See cervical spine Xrays reports should include the anomalies of the transverse process of the 7th cervical vertebra: elongation, enlargement, downwards beaking; because they are commonly present in patients with TOS who had a positive triad.

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