Thoracic Outlet Syndrome (TOS)

A medical condition in which the nerves and blood vessels supplying the arm get compressed as they exit the chest. Normally, these structures pass through a space formed between the first rib, collar bone and the neck muscles. In some people, repetitive arm motion can lead to narrowing of that space and compression of these vital structures over time. 

TOS is most often seen in people whose work involves repetitive arm motion such as:

  • Computer programmers
  • Teachers
  • Secretaries
  • Construction workers
  • Young athletes

TOS Symptoms

The symptoms an vary depending on the structure that is compressed. The brachial plexus nerve is by far the most common structure involved and can lead to recurrent episodes of arm pain, numbness and even weakness. Since these symptoms are non-specific and overlap with other musculoskeletal problems, this diagnosis is difficult to make and often delayed. 

There are no definitive blood tests or radiologic images to diagnose TOS so the diagnosis is made by taking a thorough history of the patient’s symptoms, ruling out other more common causes and performing specifics maneuvers to confirm the presence of a narrowed outlet.

TOS Treatment Options

Once the diagnosis is made, treatment options vary depending on the severity of symptoms and the patient’s expectations.

Patients with Mild Discomfort:

  • TOS-specific physical therapy designed to widen the thoracic outlet is recommended and may offer long term relief.

Patients with Worsening or Severe Symptoms:

  • Surgical decompression may be offered. This involves making a small incision in the neck and surgically removing the first rib and the muscles attached to it thus widening the thoracic outlet and removing all compression off the nerves and vessels entering the arm.

UI Difference

Our vascular and cardiothoracic surgeons have advanced training and experience in the diagnosis and treatment of TOS in both adult and pediatric patients. A diagnosis is challenging since many symptoms overlap with other more common musculoskeletal issues of the upper extremities. If you are not getting pain relief with your current treatment options, get a second opinion from our specialists.

Care Team