Demystifying thoracic outlet syndrome: What you need to know

Imagine yourself in this scenario: The fingers on your left hand are numb. There’s pain off and on in your shoulder and neck. Your grip is suddenly weak, almost as if your muscles are wasting away. And yet, the doctors tell you there’s nothing wrong. Eventually, you start to wonder if it might all be in your head.

Unfortunately, this scenario is all too real for many people with thoracic outlet syndrome. But there is good news if you’re experiencing the above situation — your symptoms are real, and there are real ways to relieve your pain.

Why athletes are more likely to develop thoracic outlet syndrome

Thoracic outlet syndrome is a condition that is most common in athletes, although virtually anybody can get it. It happens when the nerves, arteries or veins in the space between your collarbone and first rib are compressed. That space is called the thoracic outlet.

Although there are a few other causes of thoracic outlet syndrome, it is typically caused by overuse or repetitive use injuries. This is why you most commonly hear about this problem related to athletes, especially ones who use overhead motions, such as tennis players, baseball and softball players, volleyball players, swimmers and gymnasts.

Think of it like this. There is a muscle that runs through this thoracic outlet. Just like any muscle, this muscle — called the scalene muscle — gets bigger every time you stretch it and work it. It’s the same way for all the other muscles in your body, which is why people work out — so their muscles will grow bigger.

But in this case, as that scalene muscle is worked and stretched through repetitive use, it also shortens. So, over time, it gets bigger and shorter, pushing it into a state of prolonged spasm and shortening.

Now, bear with me for a quick anatomy lesson. That scalene muscle runs down your cervical spine and attaches to your rib, crossing over some nerves, arteries and veins. What causes the problem in 95 percent of people with thoracic outlet syndrome is the nerves. As the scalene muscle grows, the nerves get pinched between your collarbone and first rib, causing the usual symptoms of a pinched nerve — pain, numbness, tingling, weakness and tightness from the neck and upper back all the way down the arm and into the hand.

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Related: How to help your teen prevent sports injuries

How is thoracic outlet syndrome diagnosed?

Getting to the right diagnosis can be difficult. Thoracic outlet syndrome is a functional disorder, meaning there’s no structural abnormality to show on an MRI or CAT scan.

Here’s what the typical path to diagnosis often looks like for many athletes. A sports medicine physician assumes the symptoms are caused by a more common issue like a rotator cuff injury or a bad disc. But then, puzzlingly, an MRI of the shoulder and neck comes up clean. The next step is usually physical therapy to stretch out the muscle and correct any posture or technique problems. But when that doesn’t relieve the symptoms, they start to think what else it could be — and eventually land on thoracic outlet syndrome.

But if you are experiencing these symptoms of pain, tingling, numbness or weakness, know that you aren’t crazy. It might just be a classic case of thoracic outlet syndrome.

Unfortunately, this path to diagnosis can be frustrating. It’s not uncommon for people to see five or even 10 physicians before finally figuring out the cause. Sometimes, thoracic outlet syndrome is actually diagnosed by a physical therapist who notices that something isn’t quite right. And sometimes, when the imaging studies are normal but they still complain of pain or numbness, some people are referred to a psychiatrist.

But if you are experiencing these symptoms of pain, tingling, numbness or weakness, know that you aren’t crazy. It might just be a classic case of thoracic outlet syndrome.

Treatment options for thoracic outlet syndrome

If caught early, some people find non-surgical therapy is an effective way to relieve the problem. Therapy will focus on core strengthening exercises, posture correction and tweaks to your technique and mechanics.

But sometimes, surgery is the best option. If your symptoms are severe and disabling, to the point where it keeps you from being able to live normally, surgery is likely necessary. Many of the elite athletes I work with also turn to surgical methods to fix the issue so they can get back to their sport as quickly and effectively as possible.

I’m one of just a handful of surgeons across the country who is specifically devoted to treating thoracic outlet syndrome, and Baylor Scott & White Heart and Vascular Hospital – Dallas is one of the nation’s leading treatment centers for this condition.

I’m one of just a handful of surgeons across the country who is specifically devoted to treating thoracic outlet syndrome, and Baylor Scott & White Heart and Vascular Hospital – Dallas is one of the nation’s leading treatment centers for this condition. During surgery referred to as “First Rib Resection,” we make a 1-inch incision above the collarbone and remove the first rib, which relieves pressure on the thoracic outlet and eliminates the painful symptoms.

If you’re experiencing any kind of numbness, pain, tingling or weakness in your arm or hand, you might want to consider asking your doctor about thoracic outlet syndrome.

Related: Injury prevention: It’s all in the warm-up

Thoracic outlet syndrome isn’t just for athletes

Although commonly associated with athletes, thoracic outlet syndrome doesn’t just affect people who play sports. One population where I often see this condition might surprise you — musicians.

Think about people who play string instruments like the violin, or instruments like the horn that you have to hold up with your arms. Although playing an instrument like this doesn’t involve the force or vigor of most sports, it does involve prolonged tensing and holding of the muscles. The stimulus is the same, as that scalene muscle is constantly tensed.

Thoracic outlet syndrome can also be caused by trauma to the neck or by a congenital abnormality involving an extra rib, but most often results from repetitive use injuries.

Related: How to relieve pain from carpal tunnel syndrome

Regardless of the cause, there is good news: once you have the right diagnosis, thoracic outlet syndrome is manageable. With the right treatment and therapy, you’ll be back to doing what you love — whether that is throwing the baseball or playing the violin — in no time.

Have questions about your symptoms? Find a doctor today.

About the author

Grace Glausier
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Grace Glausier is a senior digital engagement strategist for Baylor Scott and White Health. A graduate of Baylor University, she is passionate about connecting people through powerful stories and empowering individuals toward better health.

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Demystifying thoracic outlet syndrome: What you need to know