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Vascular Services
Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

The thoracic outlet is the space between the ribs and collarbone. In Thoracic Outlet Syndrome (TOS), the blood vessels or nerves in the thoracic outlet are compressed. This compression can be caused by repetitive injury, sudden injury or anatomical anomalies.

What are the symptoms of Thoracic Outlet Syndrome?

Symptoms depend on which structure is being compressed. Neurologic TOS most commonly results in pain and numbness in fingers, shoulders and neck. Arterial TOS may results in numbness or pain in the arm, a cold or cool arm, or sores on the fingers from lack of blood flow. Venous TOS usually presents with swelling of the arm, and bluish discoloration, or varicose veins around the shoulder, which may or may not resolve with rest. If it resolves, the vein is likely not yet entirely clogged. 

How is Thoracic Outlet Syndrome diagnosed?

In addition to a obtaining your medical history and performing a physical exam, the doctor may try to reproduce symptoms through a series of tests called provocation tests. Additional tests can include:

  • X-ray
  • MRI
  • Nerve Conduction Study
  • Electromyography (EMG)
  • Doppler studies 

What are the treatment options for Thoracic Outlet Syndrome?

Most cases of neurogenic TOS can be treated through physical therapy and medications. There arealso two surgical approaches that can be used:Anterior Supraclavicluar approach or Transaxillary approach.  In both cases, the first rib and one of the neck muscles are typically removed. If there are extra ribs or muscles, these may be removed in addition to or instead of the first rib. 

Patients with arterial or venous TOS usually need intervention. Patients with a clogged vein are treated with clot buster medications and a venogram immediately, with surgery being performed if the vein can be reopened.