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Dr. Andrew Rynne

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Have arterial thoracic outlet syndrome. Developed left-side pectoral pain. Any suggestion?

Answered by
Dr. Aslam Lalani


Practicing since :2000

Answered : 356 Questions

Posted on Tue, 8 Jan 2013 in Hypertension and Heart Disease
Question: I was diagnosed with arterial thoracic outlet syndrome in September. About a month ago, I developed XXXXXXX left-side pectoral pain (axillary and lateral) that presents without activity/movement. It can occur spontaneously, without movement or activity. The pain can be constant or intermittent, lasting from minutes to hours. I also noticed that the veins in the area where the pain is (anterior chest, breast and into front of shoulder) are quite prominent and visible. There is no swelling in my arm at this time (assume no immediate venous threat). I do get pain and numbness, associated with TOS, in the neck, scapula, upper chest and arm. I am a little concerned about the chest pain, and the how the veins appear when I have this pain. I have no other issues that would lead me to believe this is cardiac related (have PVC's that come and go, but have had them for almost 3 years, wore halter monitor/Echo/EKG and found no other issues). Most recent EKG was last September 2011. I have an appointment with a vascular surgeon in January, but I am in quite a bit of discomfort. Anti-inflammatories do not seem to help. Try heat and ice with little relief. I have played soccer for over 20 years, and I have a high pain tolerance. This is a different pain than I am used to-sharp and burning, like an arrow shot through and through in the breast/pec major area. Also, the veins sticking out are a little concerning. Any suggestions? Thank you very much for your time.
Answered by Dr. Aslam Lalani 1 hour later

It is my pleasure to answer you.

Thoracic outlet syndrome symptoms occur depending on structures are compressed.
When nerves are compressed person complains about
- Numbness or tingling in fingers,
-Pain in shoulder and neck,
- Ache in arm /hand,
-Weakening grip,

When veins and/or arteries compressed then person complains about
- Arm pain and swelling,
-Throbbing lump near your collarbone,
- Pallor in one or more of your fingers or your entire hand,
-Weak or no pulse in the affected arm,

If any person having heart related pain then classical pain will be like pain in the chest may radiate to either of the arms , shoulder , or back , nature of pain may be heaviness , squeezing , burning , dull ache, rarely sharp shooting type , pain comes on exertion and relived on rest ,

In your case I feel initially you have started with neurological thoracic outlet problems and it increase to arterial and vein involvement also and causing the present problem ,

Symptoms may aggravate if a blood clot develops in a vein, the problem causing the thoracic outlet syndrome is increasing, much more pressure occurs on vein and causing prominent vein due to an underlying problem

At present I would like to advise

Avoid birth control pills as it may increase clot formation, instead use a barrier method like condoms.
Avoid strenuous physical activity using your affected arm.
Give rest to the affected arm.
Take your medicine regularly, including your thyroid related medicine
Say big NO to any addiction esp any form of tobacco use.
Take healthy food, Take bland diet, avoid spicy, fried, fatty food as you have GERD also.

Consult your vascular surgeon and follow his advice

If you have further queries, feel free to ask me
Take care

Above answer was peer-reviewed by : Dr. Shanthi.E
Follow up: Dr. Aslam Lalani 23 minutes later
The birth control method I use is intravaginal. I usually leave it in for three weeks and then start my cycle. Should I take it out then?
So the pain I am having could not possibly be thrombolysis in nature? There is no throbbing lump near the collarbone. I have some numbness there and pain above (neck) and below (chest). The pain feels XXXXXXX in the left side of chest, behind breast. What could it be, if it is present at rest? Sharp yes, but also aches in a way. Like twinges. No heaviness, shortness of breath, sweating. Occasional PVC's, but nothing alarming. What about the veins being visible? Anything to worry about?
Answered by Dr. Aslam Lalani 3 hours later
I feel it is more related to your thoracic out let syndrome which may have increased now and involving more nerves which supply to neck and chest area and causing pain to you. There are many nerves in that area called brachial plexus which are supplying to neck, arm, chest, and part of back. Same outlet problem when involves vein in that area may cause prominent vein in area where drainage of vein occurs.

If you are using intra-vaginal method for birth control, you can continue. There is no need to remove it now.

As the underlying problem which is responsible for your outlet syndrome, is till now not completely treated, you may not be getting complete relief. Pain killers, rest and other home remedies will give you only partial relief.

So my advice is to consult your vascular or cardiothoracic surgeon at the earliest and get evaluated in detail. Also start taking a final treatment for outlet syndrome.

Hope I have answered your queries. If you have further question please feel free to ask me. I will be happy to answer you.

Take care

Above answer was peer-reviewed by : Dr. Mohammed Kappan
Follow up: Dr. Aslam Lalani 5 hours later
Many thanks for your help. I did have an EMG and it showed no issues with the brachial plexus. But the thoracic surgeon said that it is very common for people with TOS to have normal EMG results. Hopefully things do not worsen over the holiday. I see the vascular surgeon in 11 days (that is the earliest I can consult him). I will continue to rest, take meds, continue therapy with the physiotherapist, and not to use the arm. It is just a little scary to see veins in my chest and shoulder. Just wanted some reassurance that it wasn't anything I needed to immediately worry about. Thanks again.
Answered by Dr. Aslam Lalani 28 minutes later

Do not panic and stay relaxed.

You can consult the doctor as planned. In the interim, take proper rest and sleep; eat healthy food; and think positive. Your problem has solution and you will be definitely alright.

Hope this helps.
If you have no other follow-ups, please close this discussion.

Take care,

Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

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