Thoracic Outlet Syndrome (TOS) is a series of symptoms resulting from compression of the subclavian arteries and veins and the brachial plexus nerves at the upper thoracic opening. It is prevalent in females, with a male-to-female ratio of 1:3, and usually occurs in the age group of 10 to 50 years. In today’s workplace, due to long-term operation of computers, and due to improper sitting posture, the occurrence of thoracic outlet syndrome is gradually increasing. Swelling and dilated veins of the upper extremities Swelling of the upper extremities and the appearance of many dilated veins in the shoulders and upper arms that were not present in the past were diagnosed as venous thrombosis of the upper extremities by ultrasound. After thrombolytic treatment in vascular surgery, the thrombus completely disappeared, but he still felt numbness and weakness in his upper extremities. On review of venography, it was found that the axillary veins were obviously compressed when the upper limbs were abducted, and there were many widened collateral veins. CT examination revealed that the position of the subclavian vein away from the thorax was obviously abnormal, and the gap between the clavicle and the first rib was too narrow, and there was no special abnormality when the upper limbs were naturally lowered, but the blood vessels were obviously compressed when the upper limbs were lifted up and abducted. Through the first rib resection surgery, the swelling and numbness of Xiao Zhang’s affected limb completely disappeared, and he soon returned to his original work. Main symptoms of thoracic outlet syndrome The thoracic outlet is bounded by the clavicle on the upper border, the first rib on the lower border, the costoclavicular ligament on the anterior border, and the middle trapezius muscle on the posterior border. Bone and soft tissue abnormalities can lead to narrowing of the thoracic outlet channel, compression of the blood vessels and nerves in it, resulting in the following symptoms: 1, symptoms of vascular compression 2, swelling and heaviness of the upper limbs 3, blotchy bruising of the skin of the hands 4, enhanced arterial pulsations in the area above the clavicle 5, neck and shoulder pain and discomfort, which is aggravated at night 6, upper limbs are easily tired and fatigued 7, dilatation of superficial veins in the arms 8, nerve compression symptoms 9, forearm and hand paresthesia 9, forearm and hand paralysis 9, nerve compression symptoms Nerve compression symptoms 9, forearm and hand paralysis 10, hand muscle atrophy 11, impaired fine hand movement 12, muscle spasm of the inner forearm 13, tingling and numbness of the skin of the neck, shoulder and hand What kind of patients need surgical treatment? If a patient develops a thrombus due to compression of the veins at the exit of the thoracic area, he/she will need to undergo a phlebotomy to remove the thrombus or be thrombolyzed through a catheter immediately. Once the thrombus is removed, further surgical resection of the anterior oblique muscle or partial removal of the first rib is required to widen the entire thoracic outlet to prevent recompression of the vein to form a thrombus and the possibility of pulmonary embolism. If the veins become stenotic with repeated compression, balloon dilatation can be used to improve venous return to the upper extremities and reduce the symptoms of upper extremity swelling, but first rib resection is also required to relieve external compression. Arterial compression resulting in ischemia or Raynaud’s symptoms at the fingertips requires reconstruction of the affected arteries, either by interposition of an artificial vessel or by stenting via the endoluminal route to improve distal blood supply, but also requires concomitant first rib resection. Most of the severe nerve compression symptoms can also be relieved by first rib resection, but due to the slower recovery from nerve compression, a longer period of assisted functional exercise is usually required before basic normalization. How to prevent TOS Preventing thoracic outlet syndrome, self-care is a more effective method, usually should develop a good sitting posture. In addition, sleeping posture is also very important, some people like to sleep with their hands under their head, which will easily lead to thoracic outlet syndrome in the long run. Occupational groups should try to create a comfortable working environment, the height of the computer screen to facilitate the level of vision, the joints of the upper limbs can be naturally placed in the desk, the back of the chair should be adjusted to the height of the most comfortable, sit down when the feet just can be flat on the ground. Work state to try to meet the ergonomic requirements, so that the neck and shoulder muscles to relax, to avoid prolonged stiffness leading to muscle fibrosis. You can also participate in swimming and badminton exercises, which can strengthen the shoulders and prevent the compression of vascular nerves caused by sagging shoulders. If TOS syndrome occurs, you should consult a doctor in time. Early rehabilitation can prevent the condition from worsening.