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.