What is thoracic outlet syndrome?
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.
Types of thoracic outlet syndrome
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
Neurogenic thoracic outlet syndrome (nTOS) is when the nerves in your thoracic outlet become compressed.
Venous thoracic outlet syndrome
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
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.
Thoracic outlet syndrome symptoms
The symptoms you experience depend on which of the three types of thoracic outlet syndrome you have.
Arterial thoracic outlet syndrome
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:
- Abnormal color in your hand and fingers
- Hand and fingers that feel cold or weak
- Reduced range of motion
- Swelling or numbness in your arm and hand
Neurogenic thoracic outlet syndrome
This form of the condition affects the nerves. If you have thoracic compression of the nerves, you may experience:
- Discoloration of the hand
- Hand weakness
- Pain in the neck, shoulder, arm or hand
- Pins and needles or cold feeling in the hand and fingers
Venous thoracic outlet syndrome
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:
- Aching, swelling or tingling in the affected arm
- Arm and hand fatigue
- Difficulty finding a pulse in the arm
- Limited range of motion
- Pale skin
What causes thoracic outlet syndrome?
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:
- Injury to the blood vessels
- Overuse of the arm or shoulder from playing sports or other activities
- Poor posture affecting the nerves
- Pregnancy
- Tumor pressing on the nerves
How to diagnose thoracic outlet syndrome
To diagnose thoracic outlet syndrome, your provider will ask you about your medical history, perform a physical exam and may order some testing.
Physical exam and medical history
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.
Imaging and nerve study tests
To confirm thoracic outlet syndrome, you may require one or more of these tests:
- Ultrasound to assess blood flow in your subclavian artery and vein, which will allow your provider to see any compression or narrowing of blood vessels.
- X-ray to identify any physical abnormalities that may be compressing nerves or blood vessels in the thoracic outlet, such as an extra rib or bone spurs.
- Computerized tomography (CT) scan to see both structural abnormalities and vascular compressions. CT scans can also use contrast dye so your healthcare team can better see your blood vessels.
- Magnetic resonance imaging (MRI) scan to look at any compression or inflammation in your soft tissues, such as your muscles and ligaments.
- Arteriography is also known as an angiogram. It uses both contrast dye and X-ray imaging to visualize blood flow in your subclavian artery and can identify narrowing or blockages.
- Venography tests evaluate the subclavian vein to detect compression or blood clots associated with TOS.
- Electromyography (EMG) assesses the electrical activity of your muscles to identify any nerve disruption.
- Electromyography and nerve conduction studies to see how well the muscles and nerves in the arm and hand function.
- Imaging tests to look for problems with the bones, soft tissues and blood vessels in and around the thoracic outlet.
- Special tests for thoracic outlet syndrome that gauge blood circulation in the arm and hand.
Thoracic outlet syndrome treatment
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.
Lifestyle changes
There are several lifestyle changes you can implement to help with thoracic outlet syndrome, including:
- Changes to your daily routine: Your physician or a physical therapist can help you modify or avoid activities that worsen symptoms. For example, you’ll want to avoid intense physical activity or activities that involve heavy weight pressing down on your shoulders, which can stress your collarbone.
- Weight loss: Losing weight can help relieve strain on the shoulder muscles.
Medication
Ibuprofen and other nonsteroidal anti-inflammatory medicines can reduce pain and swelling. Other medications may be necessary to prevent blood clots.
Physical therapy
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.
Surgery
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.
- First rib resection: A surgeon will remove the extra rib and release the tissue compressing the nerves or blood vessels, relieving the pressure and reducing symptoms. This is used for neurogenic, venous and arterial TOS.
- Scalenectomy: This procedure removes the scalene muscles, which can compress nerves and blood vessels in the thoracic outlet. This procedure is typically performed for neurogenic thoracic outlet syndrome.
- Balloon angioplasty and stenting: For arterial or venous TOS, this procedure opens narrowed arteries or veins to improve blood flow, but usually is not done without initially removing the first rib.
- Thrombectomy: For venous TOS, this surgery removes any blood clots.
Find a location near you
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.
Baylor Scott & White All Saints Medical Center - Fort Worth
1400 8th Ave , Fort Worth, TX, 76104
Baylor Scott & White Cardiac and Thoracic Surgery - Fort Worth
1250 8th Ave Ste 200, Fort Worth, TX, 76104- Monday: 8:00 am - 4:30 pm
- Tuesday: 8:00 am - 4:30 pm
- Wednesday: 8:00 am - 4:30 pm
- Thursday: 8:00 am - 4:30 pm
- Friday: 8:00 am - 4:30 pm
Baylor Scott & White Cardiac and Thoracic Surgery - Lubbock
3711 22nd St Ste B, Lubbock, TX, 79410
Baylor Scott & White Cardiac and Thoracic Surgery - Odessa
420 E 6th St Ste 102, Odessa, TX, 79761
Baylor Scott & White Cardiac and Thoracic Surgery - Weatherford
2035 Fort Worth Hwy Ste 100, Weatherford, TX, 76086
Baylor Scott & White Cardiothoracic Surgery - Irving
1110 Cottonwood Ln Ste 215, Irving, TX, 75038- Monday: 8:30 am - 4:30 pm
- Tuesday: 8:30 am - 4:30 pm
- Wednesday: 8:30 am - 4:30 pm
- Thursday: 8:30 am - 4:30 pm
- Friday: 8:30 am - 4:30 pm
Baylor Scott & White Center for Thoracic Surgery - Dallas
3410 Worth St Ste 760, Dallas, TX, 75246- Monday: 8:00 am - 4:30 pm
- Tuesday: 8:00 am - 4:30 pm
- Wednesday: 8:00 am - 4:30 pm
- Thursday: 8:00 am - 4:30 pm
- Friday: 8:00 am - 4:30 pm
Baylor Scott & White Center for Thoracic Surgery - Lubbock
3711 22nd St Ste B, Lubbock, TX, 79410
Baylor Scott & White Center for Thoracic Surgery - Rockwall
6701 Heritage Pkwy Ste 130, Rockwall, TX, 75087
Baylor Scott & White Center for Thoracic Surgery - Tyler
1321 S Beckham Ave , Tyler, TX, 75702
Baylor Scott & White Center for Thoracic Surgery - Waxahachie
2480 N Interstate 35E , Waxahachie, TX, 75165
Baylor Scott & White Clinic - Round Rock 302 University
302 University Blvd , Round Rock, TX, 78665- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor Scott & White Clinic - Temple
2401 S 31st St , Temple, TX, 76508- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor Scott & White Heart and Vascular Hospital - Fort Worth
1400 8th Ave Bldg A, 6th Floor, Fort Worth, TX, 76104
Baylor Scott & White Hillcrest Cardiology Clinic
50 Hillcrest Medical Blvd Ste 303, Waco, TX, 76712- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor Scott & White Hillcrest Cardiothoracic and Vascular Surgery
50 Hillcrest Medical Blvd Ste 303-B, Waco, TX, 76712- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor Scott & White Medical Center - Centennial
12505 Lebanon Rd , Frisco, TX, 75035
Baylor Scott & White Medical Center - Frisco
5601 Warren Pkwy , Frisco, TX, 75034
Baylor Scott & White Medical Center - Grapevine
1650 W College St , Grapevine, TX, 76051
Baylor Scott & White Medical Center - Hillcrest
100 Hillcrest Medical Blvd , Waco, TX, 76712
Baylor Scott & White Medical Center - Irving
1901 N MacArthur Blvd , Irving, TX, 75061
Baylor Scott & White Medical Center - Lake Pointe
6800 Scenic Dr , Rowlett, TX, 75088
Baylor Scott & White Medical Center - Lakeway
100 Medical Pkwy , Lakeway, TX, 78738
Baylor Scott & White Medical Center - McKinney
5252 W University Dr Highway 380 at Lake Forest Drive, McKinney, TX, 75071
Baylor Scott & White Medical Center - Plano
4700 Alliance Blvd , Plano, TX, 75093
Baylor Scott & White Medical Center - Round Rock
300 University Blvd , Round Rock, TX, 78665
Baylor Scott & White Medical Center - Temple
2401 S 31st St , Temple, TX, 76508
Baylor Scott & White Medical Center - Waxahachie
2400 N Interstate 35E , Waxahachie, TX, 75165
Baylor Scott & White Specialty Clinic - Killeen Hemingway
2405 S Clear Creek Rd , Killeen, TX, 76549- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor Scott & White The Heart Hospital - Denton
2801 S Mayhill Rd , Denton, TX, 76208
Baylor Scott & White The Heart Hospital - Plano
1100 Allied Dr , Plano, TX, 75093
Baylor Scott & White The Heart Hospital Cardiovascular Clinic - Denton
3341 Unicorn Lake Blvd , Denton, TX, 76210- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
