Hand, arm, shoulder and neck pain, swelling in the hand and arm, numbness and tingling, color changes in the hand and a feeling of coolness in the finger may all be signs of thoracic outlet syndrome.  Thoracic outlet syndrome is a group of symptoms caused by pressure against the bundle of nerves and/or the arteries and veins that come originate at the spinal cord at the neck as they pass under muscles and through the narrow passageway between the collarbone and the 1st rib.  The nerves supply sensation and muscle power to the arms and the arteries and veins provide blood supply to the arm.

   The pressure against these structures is caused by tight muscles and ligaments in the neck, shoulder and chest muscles.  Occasionally, the pressure is also caused by bony abnormalities in the thoracic outlet such as when people are born with an extra rib in the neck area called the “cervical rib” (this is rare – occurring only in about 1% of the population).

  Symptoms of thoracic outlet can mimic other nerve compression syndromes such as carpal tunnel syndrome or cubital tunnel syndrome.  Pain can be mild or severe, throughout one arm or throughout both.

  Positioning will often make symptoms worse.  For example, holding the hands above shoulder level (reaching onto a shelf) or at shoulder level for a period of time (blow-drying your hair, holding a phone) can increase symptoms.  Driving a car can also increase pain.  Neck pain, migraines, shoulder pain, and a sense of tiredness or heaviness in the arm can also be caused by thoracic outlet syndrome.  Other symptoms may include tenderness over the neck muscles or around the collarbone, pressure on these areas causing pain or tingling in the arm, pain in the shoulder or arm with neck movements, and tenderness in the armpit.  Even odd sensations in the face or ringing in the ear or ear pain can be caused by thoracic outlet syndrome.  It is not unusual for symptoms to feel worse at night after having used the arms throughout the day.

Although one of the most common causes of thoracic outlet syndrome is a history of a whiplash type of injury, poor posture while performing computer work is also a major cause of symptoms.
Posture correction can be the key to easing or preventing symptoms of thoracic outlet.  Often while typing, the chest muscles become tight, the shoulders round forward, and the chin juts forward.  This tightens the neck muscles that then pull the 1st rib up and narrow the space in which the nerves, arteries and veins pass through the thoracic outlet.  Shallow breathing can also over-develop the muscles around the thoracic outlet and cause a narrowing of the space. 

Stretching to ease tightness in the neck muscles is very important.  It is also essential to strengthen the muscles that hold the head over the shoulders.  Practicing diaphragmatic breathing (deep, abdominal breathing) rather than using the shallow muscles can help ease symptoms with the added bonus of being a good way to relieve stress and tension.

If you suspect you have thoracic outlet syndrome, seek out early medical attention.  Practice techniques to improve posture.  Practice diaphragmatic breathing.  Seek out further information on providing an ergonomically sound work environment that improves work comfort and posture. 

The American Academy of Orthopaedic Surgeons recommends the following:

If you have symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder because this depresses the collarbone and increases pressure on the thoracic outlet. You could also do some simple exercises to keep your shoulder muscles strong. Here are four that you can try; 10 repetitions of each exercise should be done twice daily:

• Corner Stretch - Stand in a corner (about 1 foot from the corner) with your hands at shoulder height, one on each wall. Lean into the corner until you feel a gentle stretch across your chest. Hold for 5 seconds.
  
• Neck Stretch - Put your left hand on your head, and your right hand behind your back. Pull your head toward your left shoulder until you feel a gentle stretch on the right side of your neck. Hold for 5 seconds. Switch hand positions and repeat the exercise in the opposite direction.
  
• Shoulder Rolls - Shrug your shoulders up, back, and then down in a circular motion.
  
• Neck Retraction - Pull your head straight back, keeping your jaw level. Hold for 5 seconds.

As with any exercise program, if any of these exercise cause pain, stop immediately!
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing at the Hand Therapy & Occupational Fitness Center in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.