What Is Thoracic Outlet Syndrome?
Thoracic outlet syndrome (TOS) is a group of conditions that occur when you have compressed nerves or blood vessels in the thoracic outlet. The thoracic outlet is the triangular space between your collarbone, first rib, and a muscle in your back called the middle scalene.
Some people naturally have a smaller thoracic outlet than others, leading to compression over time. Others may develop the condition after injuring their ribs or collarbone.
Types of Thoracic Outlet Syndrome
There are a few types of thoracic outlet syndrome, depending on what nerves or blood vessels are compressed:
- Neurogenic thoracic outlet syndrome—This is the most common type of TOS. It occurs when your brachial plexus gets compressed. The brachial plexus is a network of nerves in your shoulders, arms, and hands.
- Venous thoracic outlet syndrome—This type of TOS occurs when one of the veins under your collarbone gets compressed. It can lead to blood clots.
- Arterial venous thoracic outlet syndrome—This is the least common type of TOS. It occurs when one of the arteries under your collarbone gets compressed. As a result, the compressed artery bulges, known as an aneurysm.
Why Choose University of Utah Health?
At U of U Health, our cardiothoracic specialists are among only a few in the nation that offer robotic surgery for thoracic outlet syndrome. We use the newest, most advanced techniques that offer patients optimal outcomes. Compared with patients who have open surgery, our patients recover more quickly and experience less pain.
Our cardiothoracic surgery team, which includes the additional expertise of neurosurgeons and vascular surgeons for some surgeries, performs among the highest volume of procedures in the Mountain West region. We continually research and implement new treatments to stay on the leading edge of surgical care.
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Thoracic Outlet Syndrome Symptoms
TOS symptoms can vary depending on what type of thoracic outlet syndrome you have.
Neurogenic TOS may cause:
- numbness and tingling;
- pain through your neck, shoulder, arm, or hand; or
- weak grip strength.
Venous TOS may cause numbness and tingling along with:
- bluish or purplish hands,
- noticeable chest veins, and
If you have arterial TOS, you may have:
- cold fingers or hands,
- lack of color in your fingers or hand, and
- a weak pulse in your affected arm.
Thoracic Outlet Syndrome Pain
All types of thoracic outlet syndrome can cause hand or arm pain. If you have neurogenic TOS, the pain may extend to your neck. Your arm may also get tired easily.
Thoracic Outlet Syndrome Causes
Often, people develop thoracic outlet syndrome because they have a naturally small thoracic outlet. Other causes and risk factors for thoracic outlet syndrome include:
- jobs or hobbies that involve repetitive overhead movements, such as rock climbing or construction work, and
- traumatic injuries to your first rib or collarbone.
Thoracic Outlet Syndrome Diagnosis
Diagnosing thoracic outlet syndrome often takes some time. Many people with TOS have symptoms that are similar to several other conditions. It’s common to receive a misdiagnosis before seeing a specialist for TOS.
At U of U Health, our cardiothoracic specialists understand what tests to use to diagnose TOS. We’ll ask you to describe all your symptoms. We’ll also ask you to list treatments you’ve tried and whether those treatments have offered relief.
Thoracic Outlet Syndrome Tests
We may use imaging tests, such as:
- CT scans or MRIs to look at your nerves or blood vessels, or
- venograms, imaging tests that use a contrast dye injection to get a closer look at your veins.
We may also inject a numbing medicine into the anterior scalene muscle in your back. If the injection helps relieve your symptoms, it could mean that you have neurogenic TOS.
Thoracic Outlet Syndrome Treatment
Our specialists offer several treatment options for thoracic outlet syndrome. If you have venous or arterial thoracic outlet syndrome, we’ll prescribe blood thinner medications to reduce your risk of blood clots.
Thoracic Outlet Syndrome Physical Therapy
Physical therapy may be an effective treatment for some patients with neurogenic thoracic outlet syndrome. A physical therapist prescribes exercises to strengthen and stretch your back muscles.
These exercises may improve your posture and relieve neurogenic TOS symptoms. Physical therapy isn’t typically a good treatment for patients with venous or arterial thoracic outlet syndrome.
Thoracic Outlet Syndrome Surgery
We typically recommend surgery if you have:
- arterial thoracic outlet syndrome,
- venous thoracic outlet syndrome, or
- neurogenic thoracic outlet syndrome that doesn’t improve with physical therapy.
During surgery, we will remove your first rib so your arteries, veins, and nerves have more space. This procedure is called a first rib resection.
How To Prevent Thoracic Outlet Syndrome
There’s no guaranteed way to prevent thoracic outlet syndrome. You may reduce your risk by limiting repetitive overhead movements. You may also perform exercises that strengthen your back muscles and practice proper posture.
What Aggravates Thoracic Outlet Syndrome?
Reaching your arms overhead can aggravate thoracic outlet syndrome. You should also avoid carrying heavy bags on one shoulder, which can increase pressure on your thoracic outlet.