Upper limbs

Thoracic Outlet Syndrome

by Uperform

The cervicothoracic outlet is a triangular space delimited by the posterior edge of the anterior scalene muscle, the anterior edge of the middle scalene muscle and the superior surface of the first rib.

1) A bit of anatomy:


This space corresponds to a passageway for the several vascular and nervous structures linking the neck and the arms.





2) What does this syndrome mean? 


This pathology represents a group of disorders due to compression exerted on the nerves, arteries and/or veins passing between the neck and the thorax.


  • When nerves are compressed, tingling sensations occur in the hands, upper limb or neck
  • When arteries are compressed, upper limbs become pale and cold
  • When veins are compressed, limbs swell and the skin takes on a bluish appearance


These compressions generally occur in this small passage located between the neck and the thorax. However, the exact causes of these cuts are sometimes still poorly understood. Several avenues have been put forward: 

  • An anatomical anomaly (bone or musculo-ligament) favoring the compression of nerves or vessels
  • A posture defect: head forward, shoulders drooping
  • Trauma or a false movement
  • Excessive pressure on the joints, which can be caused by being overweight, or carrying a heavy backpack
  • Pregnancy, which promotes joint relaxation

Note that this syndrome will be more common in women and will generally occur between the ages of 35 and 55.


3) Is that bad ?

The extent of the injury may vary depending on the compressed structure and the degree of compression. It is still a pathology that will require professional follow-up.

The diagnosis is then based on the interrogation and the clinical examination carried out by the doctor. These are confirmed by medical imaging (radio, MRI, angiography, EMG).

It is interesting to note that from one case to another, the symptomatology can vary. This sometimes makes the diagnosis of the pathology difficult.

It is all of these examinations that will determine the severity as well as the therapeutic approach, whether surgical or not. 



4) Is surgery an option?


Conservative treatment remains the option of choice for the treatment of this syndrome. It will be based on the association of physiotherapy and medical treatment, with the use of analgesics.


However, surgery may be necessary if an anatomical abnormality or pressure on large blood vessels is confirmed, or if symptoms continue to progress.

The decision to operate or not will therefore be made following a discussion with the orthopedist in charge of your case.



5) How is rehabilitation going?


Conservative and post-operative treatment are similar on many points. 

It will start with an immobilization of the shoulder to allow time for the tendon to heal.


Respecting the healing process, the work will then focus on:

  • Isolation of the circumstances in which the problem appeared
  • Articular mobility of the neck, shoulder and thoracic spine
  • Muscle strengthening promoting the opening of the rib cage



6) What can I do to speed up the process?


In order to speed up the healing process, be sure to follow the recommendations of the health professionals with whom you work. 

Laziness or, on the contrary, overzealousness, will be your enemies.
Conversely, discipline, rigor, perseverance as well as a positive and voluntary state of mind will help you get back in top shape as soon as possible!