ON TOS, TREATMENT AND FLY FISHING
On March 11, a week before her 20th birthday, Marissa Paul, a Southwestern Illinois College student, noticed that when she stood up after sitting in a recliner, her arms were two different colors. She made a mental note of the difference, but explained it away: Surely this was the result of changes in blood circulation caused by the position she’d held in the chair.
The next morning, her left arm was bright purple and swollen—and she was in pain. Now concerned, Paul made an appointment for an immediate visit to a physician. An ultrasound test indicated that a blood clot was causing the discoloration and edema. Paul was transferred to a nearby hospital for a venogram, an X-ray test that shows blood flow through the veins. She was then referred to Robert Thompson, MD, director of the Washington University and Barnes-Jewish Center for Thoracic Outlet Syndrome. An expert in thoracic outlet syndrome (TOS), Thompson sees patients from across the country.
ABOUT TOS: CAUSES AND SYMPTOMS
Thompson examined Paul and made a diagnosis of TOS. Symptoms of TOS often are pain, numbness and tingling in the neck, shoulder, arm or hand. These sensations are caused by compressed nerves in the neck and shoulder. Patients also can experience swelling and discoloration of the arm caused by a clot in the vein, or they can feel weakness in the hands and fingers caused by an aneurysm of the artery.
TOS is known to sideline elite athletes who use their arms to play their sport. But the condition also can develop following a fall or a motor vehicle collision, or it can be caused by anatomical abnormalities.
Paul doesn’t know what brought on her condition, though she says she led a physically active life in her hometown of Homer, Ala., where she played softball and was a member of her high school’s jazz and symphonic bands. Outside of school, she enjoyed camping and fishing.
TREATMENT OF TOS
According to Thompson, his patient had two treatment options: Take blood thinners or undergo surgery. He says that if Paul had been treated by a physician unfamiliar with TOS, blood thinners could have been her only option, or she could have endured procedures that wouldn’t address the underlying problem. In Paul’s case, surgical treatment was required to relieve the pressure that was affecting her blood vessels and nerves.
Surgery to treat TOS involves removal of the first rib using two incisions, one just above the clavicle and the other just below it, as well as removal of the small neck muscles normally attached to the rib. In addition, the surgeon reconstructs the subclavian vein, one of the arteries that returns blood from the upper extremities to the heart. In TOS patients, this artery can be blocked.
AFTER TOS SURGERY
Paul is recovering well. According to Thompson, it won’t take long for her to be functioning at 100 percent.
Paul notes that Thompson’s office is decorated with the jerseys of famous athletes and the photos of happy patients thanking him for a job well done. She looks forward to testing out her arm with a fly rod on the Kenai River, where she likes to fish for salmon. And she hopes to send Thompson a photo of herself with an especially big catch so that he can add her to his wall of success stories.