Thoracic Outlet Syndrome Care at UC Davis Medical Center

Thoracic Outlet Syndrome Care at UC Davis Medical Center


It was just a
constant, dull ache. No matter what I was doing, no
matter how I would lay in bed, I got to where I wasn’t driving
over to see my family in Napa. My arm’s on the steering
wheel, and that rib pressing, I was feeling very weak. I would get dizzy, lightheaded. Thoracic outlet
syndrome is a syndrome that involves three different
structures as they leave the chest and go into the arm. There’s the subclavian vein,
there’s the subclavian artery, and then there are
the nerves that go from the neck down
to the arm itself. And it can occur on either
the left or the right side. But it involves the
nerves or the artery or the vein being compressed
within the structures around the neck. Thoracic outlet
syndrome is a myriad of symptoms that
occur in patients who have trauma or overuse
of their upper extremity. The most common people that get
thoracic outlet syndrome that involves the vein are people
that do repetitive motion. Swimmers, because they
do repetitive movement of overhead stretching their
arms out as they’re swimming. Pitchers, who do repetitive
movements in terms of the way they throw the ball. And the other half
of patients may have had an accident where
they actually have trauma. In 1987, I was in a
car accident where I was hit by a drunk driver. I had a lot of damage to
my chest, specifically the left rib. Our thought now that we know it
was thoracic outlet syndrome is that the ribs that were
broken had healed in a way that, over the years, they
had gotten calcifications. And it became very
deformed, and that deformity was pressing up
and compressing all of the nerves in that
subclavian vein area. There’s no real
test that tells us that it is thoracic
outlet, especially the pain and discomfort one. Many of the tests
will be negative. They’ll have an X-ray of
their neck that’s negative, or an X-ray of their
shoulder that’s negative. And it’s rare that you have an
extra cervical rib, maybe 10%. So most people,
it’ll look normal. The main thing is a good
history, a good physical, and listening to
the story, and then figuring out that
that’s what they have. So the three things I use
on my exam that really help me diagnose
neurogenic thoracic outlet is tenderness in the
scaly muscle here. When I raise their arm, I
can put my stethoscope here and listen. I can hear a bruit, which
is a noise in the artery. Reflection, some
compression of the artery. And then, the elevator
arm stress test is when you put both
arms like this and pinch. And if you have no
thoracic outlet, you should be able to do
this for three minutes without numbness, tingling,
or any discomfort. Those with thoracic outlet
will get numbness and tingling. Their fourth and fifth
finger will quit working, and they’ll start
dropping their arm a little bit because it’s tired. Here, I had three years
of all these appointments with doctors. And I’m not sure what it was. All these exams. And then here, this one
was so quick with her. Hi. How are you doing? Yep. And she touched my
neck here, which was pretty swollen and very puffy. And she just– within a
matter of just a few minutes, she was very confident
that that’s what it was and she could fix it. The minute that a patient gets
diagnosed with thoracic outlet syndrome, the real question
is, what type do they have? Do they have venous? Do they have arterial? Do they have neurogenic? Or do they have a combination
of arterial and neurogenic thoracic outlet syndrome? Not too many people operate
on thoracic outlet syndrome in the whole country. There’s probably
five to six centers. We make an incision
underneath the arm, go in and remove the
rib, the scaly muscle, preserving the vein,
the artery, and nerve. The operation takes
about an hour and a half. And they stay in the
hospital one night. And then they go
into physical therapy two weeks after
intervention with surgery. And again, hopefully,
now they’ll improve, because the rib’s not
there pushing on the nerve. Immediately, when I woke
up, I felt better, other than the physical
pain of the incision. And I have a whole team
now of about five of us that can do this procedure
and help get them in and get diagnosed and treated. I truly feel like I’ve
gotten my life back. And it’s just amazing. And I have all the faith in Dr.
Humphries and Dr. Freischlag. They’re both my heroes.

34 thoughts on “Thoracic Outlet Syndrome Care at UC Davis Medical Center”

  1. good for you… they fix you,,,,,  i m dong the stretching,  the proper one ,,, so i can avoid to have surgery

  2. and surgery is the only option!!!! Geees! before having you cut open, and having stuff remove (which are probably useful) would'nt you rather try either manual therapy for relaxing the scalen muscle, small pectoral and seeing if the mobility of the first rib and clavicule are ok…I mean try chiropractic, physiotherapy whatever works to do what i just said above… And of course they don't talk about the consequences post-surgery…

  3. My mother had the Cervical ribs on both sides. She got them removed in the 90's. I have been feelings numbness in my arms for many years and I think I have the cervical ribs too. 🙁

  4. I had this surgery done to me… twice… 2008 and 2012. What are the chances?! (Yes, both my first ribs are removed.)

  5. Hi Doctor , please can you help me with this ??, two weeks ago My father had an open heart surgery for coronory bypass,, and now he is doing well in general , but he has some pain in his left shoulder down to his elbow and arm , associated with numbness in his tow fingers,,,, please Dr could this be a case of thoracic outlet syndrome ?? how can we help him in this critical stage of his recovery??? thank you Dr

  6. I'm homeless living in a car, I think I got this, but my doctor told me that I just have bad posture. but what u just described is exactly how I felt even b4 I started to live in the car. because i have limited funds, other then an operation is there any other treatments?

  7. hello
    do you treat private international individuals? I am living in Sweden at the moment but coming to California in 8 weeks and suffer many of the symptoms of TOS. My fingers tingle constantly, I have aches in the arms, and I lost strength in my arms. Prior to an accident 14 months ago during which I landed on my head while snowboarding, I was in great health. 7% body fat, could easily bench press 200lbs, weighed 190lbs at 6ft 1inch tall so all in all in great physical shape. Since the accident I first had terrible neck and back pain which with a lot of treatment and therapy went away, but the arm pain came around 1 month after I finished back and neck treatment. Since then I have had EMG and ENeG scans and MRI scans that have shown little to nothing.

  8. I'm currently at 4 plus years of symptoms, only worsening drastically over time. Dr. Newkirk has now recommended I see your facility for consult, MRA/MRV/MRI and possible surgery. Can you tell me if your facility accepts work comp? thank you in advance

  9. Hello, any doctors whom you would recommend in New York City area? I have been in pain for two years. thank you

  10. I find out my from ultrasound by lifting my arm in difference positions and show the uneven pulse, so i did physical therapy with out procedure and loose weight is definitely my symptoms are going away

  11. i have venous TOS had a dvt in my subclavien vein was treated with thrombolysis and been on xarelto since, does your center use the supraclavicular approach?

  12. Hi there. I was diagnosed with thoracic outlet syndrome just recently by a cardiologist in Los Angeles. I’ve had it since I can remember. I don’t mind going to UC Davis to get checked out, but do you recommend a doctor in LA? My left arm turns purple and splotchy when i pull my shoulders back where they should be in seconds and if I raise my left arm for a few seconds, there is no pulse to be found. The cardiologist ended up making me a science display for his nurses and other doctors in the office, so they all came in to feel my “ghost arm”, but I can’t seem to find anyone down here that knows ANYTHING about it. Anyway, I’d love to run some tests and see which type of TOS I have to see if it can be treated, because it hasn’t been the easiest thing to deal with for a very physically active me and I’d love to be able to pull my shoulders back and have good posture. I’d just love some guidance or advice on the matter. 🙂

  13. I had much of my pec minor on my right side removed due to pain. When the doc would pull my arm back, the artery… I believe the axilary artery was compressed against the head of the humerus. Regardless, after some months. there was a release. Today, I have some tension in my other shoulder/upper back as a result of the release and rotation. It isn't a big deal and the original pain on the other side is gone. The thing I dislike is the asymmetry in my upper body as a result of the surgery and release. One thing I never mentioned and nobody ever mentioned was my my scoliosis. My guess is my problem was due to the scoliosis and building up my muscles through weight training.

  14. I have been trying to contact UC DAVIS as I am from Australia with 3 types of TOS. Four surgeries. 3 surgeries last year and one this year. I am an icu nurse and can’t return to work untill I can handle my work again. Please reply here or if you could supply an email I could write to. I have already emailed but haven’t heard anything back. Please help! I need your help!

  15. I had an MRI due to numbness and weakness in my right arm. Had an MRI and found out I have bilateral cervical ribs how likely is it that these "extra" ribs are the cause?

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