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.
AccentCare - Fort Worth
3880 Hulen St , Fort Worth, TX, 76107
AccentCare Home Health of Brenham
526 W Main St , Brenham, TX, 77833
AccentCare Home Health of College Station
119 Medical Park Lane Ste C, Huntsville, TX, 77340
AccentCare Home Health of College Station
1605 Rock Prairie Rd Ste 206, College Station, TX, 77845
AccentCare Home Health Of Denton
225 W. Mulberry St. Ste A, Denton, TX, 76201
AccentCare Home Health Of Desoto
911 York Drive Ste 203, DeSoto, TX, 75115
AccentCare Home Health Of Fort Worth (Arlington)
700 Highlander Blvd Ste 205, Arlington, TX, 76015
AccentCare Home Health of Huntsville
122 Medical Park Lane B , Huntsville, TX, 77340
AccentCare Home Health of Marble Falls
1100 Mission Hills Dr Ste 100, Marble Falls, TX, 78654
AccentCare Home Health Of McKinney
6800 Weiskopf Ave Ste 100, McKinney, TX, 75070
AccentCare Home Health Of Taylor (Hutto)
567 Chris Kelley Blvd Ste 201, Hutto, TX, 78634
AccentCare Home Health Of Temple
3809 S General Bruce Dr Ste 105B, Temple, TX, 76502
AccentCare Home Health Of Waco
8300 Central Park Dr Ste A, Waco, TX, 76712
AdventHealth Central Texas
2201 S Clear Creek Rd , Killeen, TX, 76549
Andrews Women's Hospital at Baylor Scott & White - Fort Worth
1400 8th Ave , Fort Worth, TX, 76104
Baylor Scott & White - Hillcrest Infectious Disease Clinic
50 Hillcrest Medical Blvd MOB1, Ste 104, Waco, TX, 76712
Baylor Scott & White - Plano Brain and Spine Center
4708 Alliance Blvd Pavilion I, Ste 810, Plano, TX, 75093
Baylor Scott & White - Texas Brain and Spine Institute
900 Scott and White Dr , College Station, TX, 77845
- 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 - Texas Brain and Spine Institute - Huntsville
122 Medical Park Ln Ste A, Huntsville, TX, 77340
Baylor Scott & White - The Brenham Clinic
600 N Park St , Brenham, TX, 77833
- Monday: 7:30 am - 5:00 pm
- Tuesday: 7:30 am - 5:00 pm
- Wednesday: 7:30 am - 5:00 pm
- Thursday: 7:30 am - 5:00 pm
- Friday: 7:30 am - 5:00 pm
Baylor Scott & White 65+ Clinic
4716 Alliance Blvd Ste 500, Plano, TX, 75093
- 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 Advanced Cardiac Imaging Specialists
1100 Allied Dr , Plano, TX, 75093
Baylor Scott & White Advanced Cardiovascular and Imaging Consultants
4708 Alliance Blvd Ste 450, Plano, TX, 75093
Baylor Scott & White Advanced Digestive Care
3434 Swiss Ave Ste 200, Dallas, TX, 75204
- 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 Advanced Heart and Lung Disease Center - Fort Worth
1420 8th Ave Ste 103, Fort Worth, TX, 76104
Baylor Scott & White Advanced Heart Care - Anna
450 N Standridge Blvd , Anna, TX, 75409
Baylor Scott & White Advanced Heart Care - Decatur
2401 S FM 51 Ste 200, Decatur, TX, 76234
Baylor Scott & White Advanced Heart Care - Denton
3333 Colorado Blvd , Denton, TX, 76210
Baylor Scott & White Advanced Heart Care - Idabel, OK
4 SE Avenue A , Idabel, OK, 74745
Baylor Scott & White Advanced Heart Care - Keller (Satellite)
3124 N Tarrant Pkwy Ste 204, Keller, TX, 76177
Baylor Scott & White Advanced Heart Care - McKinney (Satellite)
5236 W University Dr Ste 4450, McKinney, TX, 75482
Baylor Scott & White Advanced Heart Care - Mt Pleasant (Satellite)
1011 N Jefferson Ave , Mt Pleasant, TX, 75455
Baylor Scott & White Advanced Heart Care - Paris
875 S Collegiate Dr , Paris, TX, 75462
Baylor Scott & White Advanced Heart Care - Plano
4716 Dexter Dr Ste 100, Plano, TX, 75093
Baylor Scott & White Advanced Heart Care - Sherman Sycamore (Satellite)
203 E Sycamore St , Sherman, TX, 75090
Baylor Scott & White Advanced Heart Care - Sulphur Springs
601 Airport Rd Ste 110, Sulphur Springs, TX, 75482
Baylor Scott & White Advanced Heart Care – Sherman Highland (Satellite)
300 N Highland Ave , Sherman, TX, 75092
Baylor Scott & White Advanced Heart Failure Clinic - Irving
2001 N MacArthur Blvd Bldg 1, Ste 360, Irving, TX, 75061
Baylor Scott & White Advanced Heart Failure Clinic - Abilene
1219 E South 11th St Ste B2, Abilene, TX, 79602
Baylor Scott & White Advanced Heart Failure Clinic - Amarillo
1901 Medi Park Dr Ste 2051, Amarillo, TX, 79106
Baylor Scott & White Advanced Heart Failure Clinic - Dallas
3410 Worth St Ste 250, 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 Advanced Heart Failure Clinic - Longview
906 Judson Rd , Longview, TX, 75601
Baylor Scott & White Advanced Heart Failure Clinic - Lubbock
3711 22nd St Ste B, Lubbock, TX, 79410
Baylor Scott & White Advanced Heart Failure Clinic - Midland/Odessa
420 E 6th St Ste 102, Odessa, TX, 79761
Baylor Scott & White Advanced Heart Failure Clinic - Tyler
1321 S Beckham Ave , Tyler, TX, 75701
Baylor Scott & White Advanced Heart Failure Clinic - Waxahachie
2360 N Interstate 35E MOB 2, Ste 310, Waxahachie, TX, 75165
Baylor Scott & White Advanced Heart Failure Specialists - Fort Worth
1250 8th Ave Ste 200, Fort Worth, TX, 76104
- 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 Advanced Lung Disease Specialists - Dallas
3410 Worth St Ste 250, Dallas, TX, 75246
- Monday: 8:30 am - 5:00 pm
- Tuesday: 8:30 am - 5:00 pm
- Wednesday: 8:30 am - 5:00 pm
- Thursday: 8:30 am - 5:00 pm
- Friday: 8:30 am - 4:30 pm
Baylor Scott & White All Saints Medical Center - Fort Worth
1400 8th Ave , Fort Worth, TX, 76104
Baylor Scott & White Ambulatory Endoscopy Center
4708 Alliance Blvd Pavilion I, Ste 210, Plano, TX, 75093
- Monday: 7:00 am - 3:00 pm
- Tuesday: 7:00 am - 3:00 pm
- Wednesday: 7:00 am - 3:00 pm
- Thursday: 7:00 am - 3:00 pm
- Friday: 7:00 am - 3:00 pm
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February 25, 2025