Thoracic Outlet Syndrome

Pain & Rehab Forum [Moderated]
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First, thanks for all the great information and advice y’all put out.

I have a question regarding TOS. I have had TOS for 20 years. My symptoms are intermittent, appearing and then resolving without specific intervention (other than continuing to move as normal). For example, I woke up this morning symptomatic without any obvious trigger. Historically (for me), the symptoms last 2-3 days and then fade away and will not re-appear for a few months.

I am curious about what causes the symptoms (feeling of peri-scapular/pec tightness and pain, cool fingertips, slightly cyanotic arm) to appear and then resolve. The literature regarding TOS talks about shortened muscles, muscle imbalances, muscular dysfunction and prolonged tonic contraction but I have had trouble finding the answer to my question of the intermittency. Can you help explain why it comes and goes? And do you have any advice for speeding up the “go” when symptoms do occur?

Thanks in advance.

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Hey mlga,

Thanks for the questions. Sorry to hear you have been dealing with TOS. The evidence is mixed on TOS and admittedly we aren’t entirely sure what’s going on. Usually there are two types: vascular and neurogenic. Neurogenic has a higher prevalence than vascular but is also quite controversial as a diagnosis. In Neurogenic TOS, many try to cite nerve impingement of brachial plexus, somewhere between the neck and shoulder region - the evidence doesn’t appear overly supportive for this narrative. Often many seek decompression surgeries for TOS due to this narrative and the outcomes appear mixed. Here are two relevant articles you may find interesting: Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis - PubMed
Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management - PubMed

The “comes and goes” part you describe is regression to the mean. I spend a good deal of time discussing the concept here: https://thelogicofrehab.com/2017/09/…ding-the-path/

Happy to discuss further.

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Hi Michael,

Thanks for the links. I will read them carefully.

Margaret

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