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Thoracic outlet syndrome (TOS) refers to a group of symptoms that affect your neck, arm and hand. It occurs when nerves or blood vessels in part of the upper chest, known as the thoracic outlet, are compressed.
The thoracic outlet is a narrow space located between your collarbone and first rib. If an injury, abnormal bone or muscle, or another factor reduces the space further, it puts pressure on your nerves, an artery or a vein.
Thoracic outlet syndrome is more common in women than men, and in most cases, it develops between the ages of 20 and 50.
This condition can affect your quality of life in a variety of ways. Pain, weakness or swelling in your arm or hand can reduce your ability to play sports or perform everyday tasks. With help from an experienced heart and vascular team, you can minimize symptoms and get back to feeling like you.
There are three types of this condition. Physicians classify thoracic outlet syndrome based on whether nerves or blood vessels are compressed.
Neurogenic thoracic outlet syndrome (NTOS) is when the nerves in your thoracic outlet become compressed.
Venous thoracic outlet syndrome (VTOS) is a condition where a vein, typically the subclavian vein that takes blood from your arms and returns it to your heart, becomes compressed in the thoracic outlet.
Arterial thoracic outlet syndrome (ATOS) occurs when the subclavian artery, which supplies oxygen-rich blood to your arms, shoulders and brain, is compressed. This is the rarest type of thoracic outlet syndrome.
The symptoms you experience depend on which of the three types of thoracic outlet syndrome you have.
The subclavian artery runs through the thoracic outlet. Pressure on this artery can limit blood flow into your arm, leading to symptoms that may include:
This form of the condition affects the nerves. If you have thoracic compression of the nerves, you may experience:
Squeezing of the subclavian vein can make it difficult for blood to flow out of the arm, which can lead to blood clots. Venous thoracic outlet syndrome may cause:
In some people, a physical abnormality can put pressure on the structures inside the thoracic outlet. One example is a cervical rib, an extra rib attached to the top of the spine. In other cases, an enlarged muscle in the neck called the scalene muscle can press on the nerves or blood vessels.
Other causes include:
To diagnose thoracic outlet syndrome, your provider will ask you about your medical history, perform a physical exam and may order some testing.
A variety of conditions, including rotator cuff injuries and problems with the discs at the top of the spine, can cause symptoms like those of thoracic outlet syndrome. As a result, your physician will want to gather as much information as possible to rule out other potential causes and definitively diagnose thoracic outlet syndrome.
Your physician will ask about your symptoms and how they’re affecting you. Next, they’ll conduct a physical exam to look for skin discoloration in the affected arm or hand and weakness in the hands or fingers.
During your exam, your physician may have you perform an elevated arm stress test. You’ll raise your arms above your head for several minutes and open and close your fists so your physician can see if symptoms occur.
To confirm thoracic outlet syndrome, you may require one or more of these tests:
Thoracic outlet syndrome is quite treatable. Your heart and vascular specialists will work with your primary care, neurology and orthopedic specialists to treat your condition, so you can feel better and get back to your active lifestyle without discomfort.
There are several lifestyle changes you can implement to help with thoracic outlet syndrome, including:
Ibuprofen and other nonsteroidal anti-inflammatory medicines can reduce pain and swelling. Other medications may be necessary to prevent blood clots.
Physical therapy is typically the first-line treatment for neurogenic TOS. A therapist assists in enhancing neck and shoulder mobility, strengthening muscles and improving your posture. Many people experience an improvement in their symptoms with this approach.
If conservative treatments don’t help, vascular surgery or cardiothoracic surgery may be a good option. The specific procedure will depend on the type of thoracic outlet syndrome you have.
Whether your physician has recommended conservative treatment or surgery for your thoracic outlet syndrome, you can find comprehensive care at our heart and vascular locations in North and Central Texas. We can coordinate your care at a location with the services you need.
