Thoracic Outlet Syndrome

Thoracic outlet syndrome is an uncommon condition. A patient's nerves and blood vessels coming from the spine or a major vessel of the patient's body pass through a narrow spacing between the shoulder and armpit continuing down the arm. As those blood vessels and nerves pass the collarbone and upper ribs, there may not be enough area, causing pressure (compression). The pressure on the nerves and vessels cause pain in the neck, shoulder, armpit, hand and can cause a weak grip. An extra cervical rib or a fibrous band between the spinal vertebra connecting to the rib that is abnormal can cause compression. Patients with injuries to a shoulder or the repetitive overuse of a shoulder are most affected with thoracic outlet syndrome.

Thoracic outlet syndrome symptoms

Symptoms can include:
  • Aching in your neck, shoulder, arm, or hand
  • Pain, numbness, or tingling of your forearm or fingers
  • Hand weakness
  • Limited range of motion of your arm
  • A depression in your shoulder
  • Pain in your neck muscles
  • Swelling and redness of your arm
  • Pale and cool arm and hand

Thoracic outlet syndrome causes

  • Having an extra rib at birth
  • An abnormality in the neck muscles at birth
  • Neck injury
  • Injury to the first rib or collarbone
  • Repetitive overhead arm movements that may cause inflammatory changes

Thoracic outlet syndrome diagnosis and tests

  • An extensive exam by a vascular surgeon that includes a detailed history and performs an exam.
  • X-Ray
  • MRI

Thoracic outlet syndrome treatments

Once your physician has diagnosed thoracic outlet syndrome, physical therapy and/or surgery may be recommended. The types of surgery that are performed to correct TOS are:
  • The removal of the extra rib and some muscles
  • Removing a section of the first rib to relieve pressure
  • Bypass surgery, to reroute the blood
The University of Kansas Health System vascular surgeons who treat thoracic outlet syndrome (TOS):
Daniel Connelly, MD, FACS
Axel Thors, DO, FACS, RPVI