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Thoracic outlet syndrome, a condition usually occurring after involvement in a car crash, causes pain in one arm that just won't go away. Rehab for this condition is long and difficult, but surgery may provide a cure.

Tens of thousands or hundreds of thousands--medical researchers aren't sure exactly how many--of people around the world develop a condition of chronic dull pain after injury called thoracic outlet syndrome. Causing pain in an arm that can radiate down to the hand or across to the chest and head, this condition most commonly occurs after injury in a car crash, but it can also occur as the result of deterioration of nerves, blood vessels, or both, due:

  • Sports injuries.
  • Repetitive motion injuries, especially using a nonergonomic keyboard.
  • Pregnancy.
  • Bad posture, slouching to one side.
  • Being born with an extra rib at the top of the rib cage, or a tight band of tissue near the neck.

In rare cases, thoracic outlet syndrome is a complication of a tumor.

The pain of thoracic outlet syndrome results from pressure on arteries, veins, or the brachial plexus, a group of nerves that runs from the armpit to the neck. The pressure can be due to either a push or pull on structures around these nerves, or from spasms of nearby muscles.

Thoracic outlet syndrome due to nerve damage affects 3 to 4 times as many women as men, but a variety of the condition caused by damage to veins is more common in men than in women, and the variety of the condition caused by damage to arteries is equally common in both sexes. 

Symptoms of Thoracic Outlet Syndrome

The primary symptom of thoracic outlet syndrome is pain in the upper arm or adjacent parts of the body that just won't go away, and that always gets worse when it is cold. Thoracic outlet syndrome may a recurring condition, triggered by doing heavy manual labor, increasing weights in a workout routine, or spending unusually long hours at a computer keyboard while slouched to one side. The pain most commonly is described as dull, but it may also be sharp, stabbing, or burning. Sometimes the pain is felt only in the fourth and fifth fingers of one hand, or just one part of the arm, or even on one side of the neck, one side of the chest, or one side of the face and head. Because stroke can cause the same pattern of pain, diagnosis by a doctor is critical.

Traditional Treatment of Thoracic Outlet Syndrome

Ice packs to relieve pain don't work well for thoracic outlet syndrome, and constant application of moist heat usually is not practical.

People who have thoracic outlet syndrome are often offered steroid injections into a joint or a muscle as a quick fix for their pain. The injections usually work at first, but larger and larger doses are necessary as time goes on, with more and more side effects, such as weight gain, fluid retention, and decreased immunity.

Botox injections are also use to treat thoracic outlet syndrome pain. They are expensive. They wear off in 3 to 4 months. And they also can cause side effects.

Physical therapy and specific exercises are often highly effective in relieving the pain of thoracic outlet syndrome, but getting results takes months. And prescription and non-prescription pain relievers such as Aspirin, Tylenol, oxycodone, morphine, and fentanyl, as well as antidepressants and anticonvulsants also relieve pain, at least temporarily but cause serious problems of their own.

Continue reading after recommendations

  • Edwards DP, Mulkern E, Raja AN, Barker P. Trans-axillary first rib excision for thoracic outlet syndrome. J R Coll Surg Edinb. Dec 1999. 44(6):362-5.
  • Vemuri C, Wittenberg AM, Caputo FJ, Earley JA, Driskill MR, Rastogi R, et al. Early effectiveness of isolated pectoralis minor tenotomy in selected patients with neurogenic thoracic outlet syndrome. J Vasc Surg. Jan 31 2013.
  • Photo courtesy of Antonio Foncubierta by Flickr : www.flickr.com/photos/afoncubierta/2744036296
  • Photo courtesy of Creator by Wikimedia Commons : commons.wikimedia.org/wiki/File:Lean_ribs.JPG