Thoracic outlet syndrome is a rare condition that occurs when there is compression of vessels and nerves in the area of the clavicle. This can happen when there is an extra cervical rib or because of a tight fibrous band that connects the spinal vertebra to the rib.

Conditions that cause pain in these structures can result from work or recreational injury, where certain stressful or repetitive tasks tear muscles in the neck or stretch the vessels and nerves that pass beneath. In some instances people are born with bony abnormalities such as a rib originating from the base of the neck that can lead to the same painful sensations, loss of feeling or weakness. In each instance a condition called thoracic outlet syndrome (TOS) may exist.

Symptoms

There may be pain in the neck and shoulders, and numbness in the last three fingers and inner forearm. Arm pain can result from abnormalities in the way the nerves and artery pass from the neck outward toward the fingers or from compression of the vein as it returns to the chest.

Treatment

TOS Surgery—Rarely, surgery may be required not only to relieve pain, but also to prevent permanent injury to the vessels and nerves of the arm. Our center offers expertise in this field with professionals uniquely qualified and dedicated to issues of arm pain.

For a technical overview of TOS surgery and information for patients undergoing surgery.

TOS Physical Therapy—Since TOS is often difficult to diagnose and treat, UT Medical Center in Knoxville has developed a specialized center for treating upper extremity pain. It consists of doctors, physical therapists and psychologists who have experience in diagnosing and treating arm pain. In many cases, the appropriate physical therapy exercises, behavioral counseling and medications can relieve arm pain.

Often, patients with neurovascular entrapment are referred to a physical therapist for evaluation and treatment of upper extremity neurovascular disorders. The physical therapist helps determine which factors are contributing to symptoms of pain, numbness, and coolness of the upper extremity.

The evaluation consists of various noninvasive tests and measurements to identify factors that might respond to non-operative management. These include ergonomic issues, posture, joint dysfunction, breathing patterns, muscle tightness and identifying multiple sites of entrapment.

The physical therapist will utilize multiple modes of treatment depending on the site or sites of neurovascular entrapment. These include modern technical modalities and hands on therapy techniques. A hallmark of the program also is the use of the Edgelow protocol, developed by Peter Edgelow a physical therapist in San Francisco. This novel approach has proven to be very effective in the non-operative management of patients with upper extremity neurovascular entrapment. The Edgelow Protocol is based on gentle stress-relieving exercises to release involved nerves, decreasing pain and arm symptoms.

The protocol is a series of exercises which are progressed in a specific fashion. This facilitates decreased muscular tension, the development of appropriate breathing patterns, increased flexibility, and increased strength. All of these help to decrease pressure at the site or sites of neurovascular entrapment and reduce pain and discomfort.

Typically, a TOS physical therapy session will last from 30 min. to one hour.

For more information about TOS Physical Therapy, contact Rehabilitation Services / Physical Therapy at 865.305.6630.

The personnel of the Center for Upper Extremity Neurovascular Disorders at UT Medical Center include the following.

Warren P. Bagley, MD           Anesthesia Pain Service

Daniel R. Bustamante, MD      Anesthesia Pain Service

David C. Cassada, MD           Division of Vascular Surgery

Michael Craig, MD                  Division of Surgical Rehabilitation

Raymond A. Dieter, MD         Division of Cardiothoracic Surgery

Wes Franks, PT                      Department of Physical Therapy

Thomas E. Gaines, MD           Division of Cardiothoracic Surgery

Jeffrey S. Hecht, MD               Division of Surgical Rehabilitation

Joseph E. Simpson, MD          Anesthesia Pain Service

This is an abbreviated version of the complete article. Click here to view the complete technical article.