Thoracic outlet syndrome is a group of symptoms produced by pressure on the nerves and/or blood vessels as they pass through the thoracic outlet. The thoracic outlet is the space between the base of the neck and the armpit. Thoracic outlet syndrome affects women more frequently than men. It typically appears between ages 20 and 50 years.
Thoracic outlet syndrome occurs due to a variety of reasons. Some of the more common causes are being born with an extra rib or muscle in the neck, being involved in activities that require stooped posture or repetitive shoulder movements or having enlargement of the neck and shoulder muscles from weight lifting or weight gain. Swimmers, volleyball players, tennis players, baseball pitchers and musicians are particularly at risk. Tumors at the top of the lung or in the neck are very rarely the cause.
Your child may complain of a dull, aching pain in the shoulder and neck that gets worse with activity. If the nerves are being compressed, your child may have numbness or tingling in the fingers and muscle weakness. When blood vessels are compressed, children often have puffiness, color change or a feeling of heaviness in the arm or hand. Symptoms can often be provoked when the arm is positioned above the shoulder or extended.
Your doctor will do a physical examination of the neck and shoulder and review your child’s symptoms. Certain maneuvers of the arm and neck can be done to reproduce your child’s symptoms during the physical exam. X-rays of the shoulder and chest may reveal an extra rib. An MRI may show muscular abnormalities and may clarify the area of compression. Electromyography (EMG) and nerve conduction study may be used to see how your child’s muscles and nerves are working.
Your child will need to rest from irritating activities until the pain and other symptoms improve. Physical therapy and an exercise program can help reduce the compression in the thoracic outlet by strengthening the chest and back muscles, stretching tight tissue, and improving posture. The physical therapist may recommend avoiding certain activities that can aggravate symptoms. If physical therapy and exercise do no improve your child’s symptoms, you doctor may recommend surgery to relieve compression of the nerve and blood vessels.
The goal is to return your child to their sport as quickly and safely as possible. If your child returns to sports or activities too soon, the injury may worsen, which could lead to permanent damage, chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Your child’s return to sport or activity will be determined by how soon their symptoms resolve, not by how many days or weeks it has been since the injury occurred. In general, the longer you have symptoms before treatment, the longer it will take to get better.
Once the child’s symptoms have resolved, they can start basic sport-specific activities and gradually progress to full activity. Your child may need to modify their activity level or technique if returning to sports causes their symptoms to recur.