Thoracic Outlet Syndrome

Thoracic Outlet Syndrome refers to conditions caused by the compression of nerves and/or blood vessels in the neck and upper chest.

Key Info About Thoracic Outlet Syndrome

  • Thoracic outlet syndrome involves pain in the neck and shoulder areas and numbness in the arms or hands.
  • It can be caused by the compression of arteries, veins, or nerves near the neck
  • There are various approaches to treatment, including surgery, that are dependent on the type of structure that is compressed.

Thoracic outlet syndrome (TOS) is a term used to describe symptoms stemming from compression of either the subclavian artery that supplies blood to the head and arms and passes beneath the clavicle (arterial thoracic outlet syndrome); the subclavian vein (venous thoracic outlet syndrome); or the brachial plexus, a group of spinal nerves emerging from the neck and leading into the arms (neurogenic thoracic outlet syndrome).

Although arterial and venous TOS are well-recognized variations of TOS, they account for less than 5% of incidents of the condition. By far, the majority of people with a diagnosis of thoracic outlet syndrome have neurogenic TOS.

Symptoms of TOS include pain in the neck and shoulder areas and numbness in the arm and hand. The diagnosis of TOS is established based on symptoms, physical examination, imaging studies such as MRI and EMG, and nerve conduction studies. Those diagnosed with neurogenic TOS are first prescribed physical therapy to increase motion in the neck and shoulders, strengthen muscles, and improve posture.

Surgery Options

Those with severe TOS symptoms, even after physical therapy, may be eligible for surgical treatment. Depending on symptoms and which structures are involved, TOS surgery can be performed by either a supraclavicular or transaxillary approach.

In the case of venous TOS, such as in Pagett-Schroetter syndrome, r a transaxillary decompression may be recommended, whereas in arterial compression, a supraclavicular approach may be preferred. Regarding neurogenic TOS, surgeons tailor the approach based on the person’s overall health and the complexity of the surgery.

Next Steps

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