Thoracic Outlet Syndrome (TOS) affects approximately 8 percent of the U.S. population. It is often referred to as a great masquerader since it can present with a range of symptoms that affect the arm and shoulder areas. The symptoms usually range from mild discomfort to constant and chronic pain, numbness and tingling, or even swelling of the neck, shoulder and arm. Because of the variety of symptoms, patients affected by TOS are often seen by a myriad of medical practitioners.
Until recently, the exact cause of TOS has not been known, and the majority of patients have been treated based on their symptoms with little to no relief. This can be frustrating for both patients and the medical community. Research from the University of Arizona has shown that in over 95 percent of TOS patients, symptoms related to the ailment are the result of a congenital malformation of the first rib. This malformation results in pinching of the blood vessels that supply the arm and shoulder as they exit the chest. Symptoms of TOS are a consequence of low blood flow to the arm and are similar to the sensation of your foot falling asleep after crossing the legs for too long.
TOS has been seen in a number of occupations such as mechanics and athletes. However, it is believed that occupations and activities that result in raising the arms above the head for prolonged periods exacerbate the symptoms in people with the underlying congenital defect.
Until the development of Magnetic Resonance Angiography (MRA), TOS has been difficult to diagnose. MRA is a non-invasive, painless medical test that helps physicians definitively diagnose and treat TOS. Just like a magnetic resonance imaging (MRI) test, these methods produce detailed pictures of the major blood vessels that are affected.
Because the surgical area is typically difficult to reach using traditional methods, a robotic-assisted approach is preferred. Robotic-assisted surgeries have smaller incisions, higher accuracy and greater precision, which has revolutionized the treatment of patients with TOS. This minimally invasive method allows for removal of the congenitally malformed area of the rib and has been associated with a lower likelihood of complications. Robotic-assisted surgeries also produce the best results with less pain and a faster recovery. More importantly, this procedure has been shown to be effective in all patients.
TOS should be considered in all patients with symptoms affecting the arm and shoulder. The best way to do this is through an MRA exam that compares the blood flow when the arms are raised to when they are in a natural position. After an MRA exam has been completed, only then should other diagnoses be explored.