Q: For the past 12 months, I’ve had this terrible pain in my arm, along with numbness and pins and needles. It’s been diagnosed as thoracic outlet syndrome (TOS) and I’ve tried nerve block injections, physio and acupuncture because I didn’t want to go on medication. But none of it has helped and the pain is so bad I can’t sleep. Do you have any other suggestions?
A: TOS occurs when the main artery, or the bundle of nerves supplying the arm, gets compressed in the space between the collarbone and the first rib. A common cause for this is the binding of an extra (cervical) rib.
Symptoms vary depending on whether the artery or the nerves or both are affected. Usually there is pain in the hand and forearm, which can be worse if the arm is raised for several minutes.
Treatments include anti-inflammatories, physio, weight loss (if overweight) and attention to posture and avoiding repetitive movements. Surgery to remove the extra rib (if there is one) or even to divide the muscle around the area is the last resort.
To find out more about your situation, ask your doctor to refer you to a specialist.
Dr Helen Winpenny
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