If you experience these symptoms, you should call your doctor right away. Problems with the blood vessels that go to the arm are serious. The arm may become somewhat blue (cyanotic), and the constriction of vessels can cause the arm and hand to swell. If the blood vessels are causing symptoms, the arm and shoulder may feel heavy and cold.
Symptoms related to the blood vessels are less common. It may be harder to hold and grip things, and the hand may feel clumsy. The arms may also feel tired when held overhead, as when using a blow dryer. Symptoms tend to get worse when driving, lifting, carrying, and writing. Numbness and tingling, called paresthesia, may accompany the pain, especially in the early hours of the morning before it's time to wake up. Occasionally pain spreads into the hand, mostly into the ring and pinky fingers. The pain may spread along the inside edge of the arm. TOS causes pain along the top of the clavicle and shoulder. As they heal, scar tissue can build up, putting pressure on the nerves and blood vessels at the thoracic outlet. In an accident, the shoulder harness of the seat belt can strain or tear the muscles. Traumatic injury from a car accident can also cause problems that lead to TOS. Heavy lifting and carrying can bulk up the scalenus muscles to the point where the nerve and arteries get squeezed.
Extra muscle or scar tissues in the scalene muscles can put extra pressure on the nerves and arteries. It can also happen in people who have an extra first rib, although this doesn't always result in TOS. Pressure on nerves and vessels can happen in people who have fractured their clavicle. For some reason, TOS affects three times as many women as men. Being overweight can cause problems with posture, and women who have very large breasts may also have a droopy posture. The poor body alignment of slouching can compress the nerves and arteries near the thoracic outlet. People with TOS often slouch their shoulders, giving them a drooped appearance. TOS symptoms are also reported by people who have to hold their arms up or out for long periods of time. People who have to hold their neck and shoulders in awkward alignment sometimes develop TOS symptoms. Neck and arm positions used at work and home may contribute to TOS. The main cause of TOS is that the nerves and blood vessels going to the arm and hand get squeezed near the thoracic outlet. The nerves and blood vessels then go under the collarbone (also known as the clavicle), through the armpit (the axilla), and down the arm to the hand. The thoracic outlet is this opening between the scalene muscles and the rib cage. The nerves and vessels travel between muscles in the neck called the scalene muscles and over the top of the rib cage. These openings are called neural foramina. Nerves come out of the spine through small openings along the side of each vertebra. The nerves and blood vessels that go into the arm and hand start at the side of the neck. This guide will help you understand what happens to cause TOS what tests will be used to diagnose the condition what can be done to relieve your pain Anatomy What is the thoracic outlet? Making the right diagnosis often takes time and can be a cause of frustration, both for you and your doctor. You will need to go through several tests to find out if TOS is actually the cause of your pain. There is no one test to accurately diagnose TOS, and other conditions can have similar symptoms. Thoracic outlet syndrome (TOS) can cause pain and numbness in the shoulder, arm, and hand.
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