Thoracic (Mid Back) Pain Nerve Compression

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Is Thoracic Outlet Syndrome Causing Your Thoracic Back Pain?

If you have a pain in your back, it is unlikely that you are suffering from thoracic outlet syndrome (TOS). This condition affects the muscles, veins and arteries in the shoulder area called the thoracic outlet. This is an opening located just above the first rib through which nerves, veins and arteries travel to reach the shoulders and arms on each side of the body. Pain, tingling and numbness are usually related to fingers, hands and arm muscles. TOS can have serious ramifications if not diagnosed correctly resulting in loss of fingers, hand and even the arm. Essentially, the blood and/or nerve supply to the arm may be completely or partially blocked.

Understanding How Thoracic Outlet Syndrome Can Cause Pain

It is estimated that some form of thoracic outlet syndrome (TOS) affects 8% of the population. Women are four times more likely to suffer from TOS, usually between the ages of 30 and 40. The condition is rare in children.

To understand how thoracic outlet disease can cause pain, just imagine that the blood supply or nerve pathways to your arms were slowly or suddenly shut down. You may feel intermittent pain, tingling and numbness in a shoulder, arm and hand. This condition is clinically difficult to diagnose because symptoms are similar to more common conditions.

There are three kinds of thoracic outlet syndrome, neurogenic (nerves), venous and arterial. Of the three types, neurogenic accounts for 85% to 90% of TOS. One of the symptoms is irritation of the shoulder muscle with compression affecting the C5 and T1 nerve roots. The individual may feel pain, numbness and tingling in the neck, upper back, shoulder, arm and hand. The patients can be tested using the 3-minute elevated arm stress test (EAST) which can help determine if the TOS has a neurogenic cause. Conservative treatment for neurogenic TOS initially includes physical therapy, muscle relaxants, anti-inflammatory medications and ergonomic changes to workplace processes. Some patients may require surgical solutions.

Venous TOS accounts for 10% to 15% of TOS cases. It is caused by vein compression between the clavicle and the first rib. A key symptom for this condition is swelling of the entire arm which also may turn a shade of blue (cyanotic) since blood supply is restricted. Immediate action to return blood flow is essential.

Arterial TOS only accounts for 2% to 5% of cases and is usually caused by the congenital condition of an anomalous cervical rib which may impede arterial flow to a limb. It may also occur in athletes who frequently raise their arms such as basketball players and volleyball players. The sudden loss of blood flow to the fingers and hands can result in amputation of fingers and hand. In these instances, immediate intervention is required to unblock blood flow.

Thoracic outlet syndrome is a complex diagnosis that requires multidisciplinary skills including vascular, neurological and orthopedic expertise. The neurosurgeons at Basic Spine are trained to recognize and diagnose the condition, and develop inter-disciplinary surgical treatment teams to assist patients suffering from thoracic outlet syndrome.


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