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Many health conditions can cause pain and other symptoms in your arms and hands, from minor muscle strains to a serious problem like a heart attack.

While thoracic outlet syndrome (TOS) is not life-threatening, it can lead to complications if left untreated. Find out about the types and symptoms of TOS, who is at risk, and how to tell if your arm pain is a sign of a more serious health problem.

What is Thoracic Outlet Syndrome?

TOS is the term used to describe a group of conditions that can put pressure on the arteries, veins, and nerves in your upper chest. It can cause symptoms like pain, coldness, and numbness in your arm and hand. TOS occurs when blood vessels or nerves in the upper chest are compressed.

TOS occurs most often among athletes but anyone of any age and gender can develop TOS. Generally, women tend to get this disorder more often than men. Neurogenic TOS is the most common form of this syndrome. Over 95% of people with TOS have the neurogenic form.

Thoracic Outlet Syndrome Symptoms

Symptoms of this condition can depend on which type of TOS you have. The most common symptoms are:

• Pain in the shoulders and neck
• Numbness or weakness in the fingers
• Having constantly cold fingers, hands, or arms

Thoracic Outlet Syndrome Causes

There are many causes of TOS. Sometimes a result of a birth abnormality, TOS is often caused by injury. Other common causes include:

• Anatomical defects
• Tumors that press on nerves
• Poor posture
• Repetitive arm and shoulder movements

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Types of Thoracic Outlet Syndrome

Your thoracic outlet is the area of your upper chest behind below your collarbone, opposite your first rib. TOS can affect the arteries, veins, or nerves in this area. There are three types of this condition, including:

• Arterial thoracic outlet syndrome
• Venous thoracic outlet syndrome
• Neurogenic thoracic outlet syndrome

Arterial thoracic outlet syndrome

Arterial thoracic outlet syndrome affects the artery that brings blood to your arm, and is usually caused by an abnormal or extra first rib. Symptoms can include:

• Pain, coldness, or paleness or change of color in the hand
• Cramping when using your arm

Arterial TOS can be treated, usually through surgery to fix your artery and to safely remove your rib, if necessary. If left untreated, arterial TOS can lead to serious complications, including:

• An aneurysm, or weak spot or bulge in your artery. Over time, the aneurysm can burst, causing life-threatening internal bleeding.
• Blood clots, which can block the flow of blood to your hands and fingers.

Venous thoracic outlet syndrome

Venous thoracic outlet syndrome affects the vein that brings blood from your arm back to your heart and may be caused by repeated use of your shoulder. Symptoms can include:

• Swelling and dark coloring in the arm
• Arm pain
• A feeling of heaviness or fullness in the arm
• Dilated chest wall veins

Depending on your specific condition, venous TOS may be treated with:

• Blood thinner medicines
• Thrombolysis, a procedure that sends medicine directly into your vein to break up a blood clot
• Venoplasty, which uses a catheter and balloon to open up your vein
• Surgery to remove blood clots, open up your vein, or decompress your thoracic outlet

If left untreated, venous TOS can lead to blood clots, including pulmonary embolism, a potentially life-threatening blood clot in your lungs.

Neurogenic thoracic outlet syndrome

Neurogenic TOS affects the nerves that bring feeling to your arm and control the muscles in your shoulder, elbow, wrist, and hand. This type of TOS usually happens because of a previous injury or trauma, or repeated motions. Symptoms can include:

• Pain, numbness, tingling, or weakness in your arm and hand
• Pain that starts in your shoulder and moves down your arm into your fingertips
• Tired feeling in your arm
• Neck pain
• Headaches at the back of your head

Treatment for neurogenic TOS may include physical therapy and medicines to reduce inflammation. If your neurogenic TOS does not improve with these treatments, you may need surgery to relieve the compression on your brachial plexus.

Who Is at Risk for TOS?

TOS affects both men and women, and can happen at any age. Some risk factors can include:

• Playing a sport with repetitive motions, like swimming, volleyball, or baseball
• Stress from repetitive tasks
• A history of trauma to your cervical spine or neck
• Poor posture

Is It Thoracic Outlet Syndrome or a Heart Attack?

In some cases, TOS can cause pain that is similar to angina, or chest pains that happen from decreased blood flow to the heart muscle. If you think you or someone else is having a heart attack, call 911 right away.

While TOS does not cause other symptoms like shortness of breath, nausea, dizziness, lightheadedness, sweating, and fatigue, it is always better to have a doctor examine you to rule out a heart attack.

To learn more about thoracic outlet syndrome or to find a vascular surgeon to treat your condition, visit the UPMC Heart and Vascular Institute or call 412-802-3333.