Thoracic outlet syndrome

Activities and hobbies are important to you. But when you have pain or weakness in your neck, shoulder, arm or hand, it can keep you from living well. We’re here to help. We use the latest and least-invasive techniques to accurately diagnose and treat thoracic outlet syndrome (TOS) so you can quickly return to the things you enjoy.

What is thoracic outlet syndrome?

The thoracic outlet is the area between your collarbone and first rib. When your blood vessels or nerves in this area become compressed, injured or irritated, it can cause a group of disorders referred to as thoracic outlet syndrome. The disorders are typically grouped by the body part affected – arteries, veins or nerves.

While thoracic outlet syndrome can happen to anyone, it’s more common in athletes, women and people between ages 20-40.

If left untreated, thoracic outlet syndrome can lead to serious complications, such as blood clots or pulmonary embolism, a life-threatening condition that happens when a blood clot travels to your lungs and suddenly blocks blood flow. Thoracic outlet syndrome can also cause permanent nerve damage.

Symptoms of thoracic outlet syndrome

Thoracic outlet syndrome (TOS) typically causes symptoms in the upper body, specifically in the neck, shoulders, arms, and hands. People with Thoracic outlet syndrome may feel pain, numbness, tingling, or weakness in these areas. If thoracic outlet syndrome symptoms are affecting your veins or arteries, you may have:

• Swelling of the arms, hand and fingers
• Numbness, tingling or pain in your fingers
• Blueish or pale hand or fingers
• Cold fingers, hands or arms
• Weakness of your neck or arm

If the condition is affecting your nerves, you may feel:

• Pain, aching, tingling or weakness in your neck, shoulder, arm or hand
• Numbness or weakness in your hand or fingers
• Weakening grip

Causes of thoracic outlet syndrome

Compressed or injured blood vessels or nerves in your thoracic outlet, which is between your collarbone and first rib, causes thoracic outlet syndrome. Doctors may not always know why the compression happens, but common causes may include:

• Injury from a car or other accident
• Repetitive movement from sports or job activity
• Poor posture
• Joint stress from being overweight or carrying heavy objects like a backpack
• Having an extra rib
• Pregnancy, which can loosen joints

Diagnosing thoracic outlet syndrome

To diagnose thoracic outlet syndrome, we’ll start with a thorough physical exam and review your health history and symptoms.

Tests we may order for you include:

• Imaging such as X-ray, ultrasound, CT scan or MRI to get a picture of your ribs, blood vessels and thoracic outlet area
• Vascular tests, such as angiography that uses X-rays and dye, to reveal the location of any blood vessel compression
• Nerve studies to evaluate your nerve function

Find out more about our heart and vascular testing and diagnosis.

Treating thoracic outlet syndrome

When thoracic outlet syndrome is treated early, physical therapy and pain relief is all you’ll likely need to treat your symptoms. Your plan to treat thoracic outlet syndrome symptoms may include:

• Medications to decrease inflammation, relieve pain, relax your muscles, or prevent and dissolve blood clots
• Physical therapy to learn exercises to strengthen your muscles and take the pressure off your blood vessels and nerves, increase your range of motion and improve your posture

Sometimes, if other treatments aren’t effective and your thoracic outlet syndrome symptoms are ongoing, we may recommend surgery. Our vascular specialists will talk with you to determine the best surgical options for you.