Numbness in hands due to thoracic outlet syndrome

Ms. Mien’s right arm was more numb when she first woke up and played sports. On July 4, Dr. Nguyen Anh Dung, Head of the Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, said that the patient had severe stenosis of the right subclavian artery root with severe stenosis of the subclavian veins on both sides, suspected to be due to Thoracic Outlet Syndrome (TOS).

Dr. Dung explains that the thoracic outlet is a narrow space between the neck and shoulders, formed by the upper ribs, just below the collarbone. The syndrome occurs when blood vessels or nerves running from the upper body to the arms are compressed by surrounding structures, leading to swelling, reduced blood flow, tingling, muscle weakness, pain and numbness in the neck, shoulders, arms or hands.

TOS is divided into three types. Neurogenic TOS (nTOS) is the most common type, characterized by compression of the brachial plexus, a network of nerves that originate from the spinal cord and control movement and sensation in the muscles of the shoulder, arm, and hand. The other two types are venous TOS (vTOS) and arterial TOS (aTOS).

vTOS occurs when one or more subclavian veins are compressed and damaged. aTOS occurs when one of the subclavian arteries is compressed. Dr. Dung said that Ms. Mien’s case had a combination of these three mechanisms, with clinical symptoms and CT images of subclavian artery and vein stenosis due to TOS syndrome.

For treatment, the team made a 5cm incision in the skin just above the clavicle, dissecting the surrounding tissue and muscles. At this time, the doctor noted that the anterior bundle of the scalene muscle was enlarged, compressing the subclavian vascular bundle, without atherosclerosis. The doctor cut the anterior bundle of the scalene muscle to widen the thoracic outlet. The surgery was completed in two hours.

One day later, Ms. Mien’s hand numbness was completely gone, she was able to resume normal activities, and was discharged from the hospital after 3 days. She was instructed to follow a healthy lifestyle to avoid stress on her shoulders and the muscles around the thoracic outlet.

Master, Doctor, Doctor Phan Vu Hong Hai, Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, said that the cause of thoracic outlet syndrome is trauma. Congenital anatomical abnormalities, bad posture (pushing the shoulders or keeping the head forward for too long), performing the same movement continuously for a long time, obesity… are also causes.

People at risk include office workers, athletes playing sports such as swimming, pitching, and football; violinists, flute players, mechanics, hairdressers, teachers, assembly line workers, etc. People who lift weights incorrectly cause muscle imbalance, and people who do heavy lifting, causing muscle swelling, also compresses blood vessels and nerves.

If left untreated, this syndrome can lead to serious complications such as axillary-subclavian vein thrombosis, chronic arm swelling and pain, gangrene or ischemic ulcers on the fingers, and pulmonary embolism. According to Dr. Hai, physical therapy is the first-line treatment for the disease. Exercises to strengthen and stretch the shoulder muscles help reduce pressure on the blood vessels and nerves in the thoracic outlet.

Patients may be prescribed anti-inflammatory drugs, pain relievers, muscle relaxants, or blood thinners (in cases of venous or arterial thoracic outlet syndrome and blood clots). If medical treatments are ineffective after a period of application, the doctor may recommend surgery.

Post-operative patients and even those without TOS should avoid carrying heavy objects to avoid increasing pressure on the shoulders and muscles around the thoracic outlet. Patients should maintain good posture, maintain a reasonable weight, avoid carrying heavy bags or backpacks on the shoulders, avoid repetitive arm movements, and breathe deeply. Meditation and stretching can help improve shoulder strength.