Thoracic Outlet Syndrome

What is thoracic outlet syndrome?

The thoracic outlet is the space between the collarbone and the first rib, and if any of the vessels or nerves in that area are damaged (known as thoracic outlet syndrome), patients can experience pain or numbness. Thoracic outlet syndrome (TOS) occurs when blood vessels in the lower neck/upper chest are compressed, causing pain, numbness and impaired circulation to areas that have restricted pathways. Thoracic outlet syndrome often is caused by physical trauma, joint pressure, posture, pregnancy or anatomical defects.

Types of Thoracic Outlet Syndrome

There are three distinct types of TOS, and the symptoms vary depending on the specific diagnosis and afflicted body part.

• Neurogenic thoracic outlet syndrome results when the brachial plexus — nerves in the spinal cord that correspond with muscle control and sensation in the shoulders, arms and hands — is compressed. This can lead to weakness, numbness or pain in the arm or hand.
• Venous thoracic outlet syndrome occurs when veins and/or arteries in the chest and lower back are compressed. Typically, swelling will occur in the arms, hands and fingers.
• Arterial thoracic outlet syndrome is caused by an aneurysm in the subclavian artery that can migrate to hands. When this happens, hands feel cold and painful.

Thoracic Outlet Syndrome Symptoms

Symptoms will vary depending on the type of TOS:

Neurogenic Symptoms:

• Limb pain, specifically in the hand, shoulder or neck
• Numbness and/or tingling in fingers
• Hand weakness or decreased mobility

Venous Symptoms:

• Bluish tint in hands and fingers
• Hand/arm fatigue or weakness
• Arm swelling
• Painful lump on or near collarbone

Arterial Symptoms:

• Hand/arm pain
• Unnatural coldness in hand/arm
• Bluish tint in hands and fingers
• Weak arm pulse

Thoracic Outlet Syndrome Treatment

Our UChicago Medicine vascular surgery team offers a wide range of thoracic outlet syndrome therapies for patients suffering from TOS. Our specialists will explain the treatments available and will work with you to decide on the best option for your condition and lifestyle.

Medical Therapies

For some patients, undergoing physical therapy can release the compression on blood vessels. Additionally, medications, such as anti-inflammatories, muscle relaxants, thrombotics and pain medication may also be recommended to manage some patients condition and alleviate symptoms.

Surgical Treatment 

If medical treatment alone does not improve symptoms, thoracic outlet syndrome surgery may be the next step. Our vascular surgeons are highly skilled in treating thoracic outlet syndrome and will recommend the best and safest surgical option to ensure longterm success .