The thoracic outlet is a small area between your collarbone, first rib and vertebra. Thoracic outlet syndrome (TOS) is a group of conditions characterized by compression of the nerves, arteries or veins in this space. Thoracic outlet syndrome can cause neck and shoulder pain, numbness and tingling of the fingers and a weak grip. If left untreated, TOS can lead to increased pain and decreased function. Certain forms of the disease can cause serious blood clots.
Thoracic outlet syndrome can be difficult to diagnose, as symptoms of it often mimic other disorders. Expert vascular specialists in the Division of Vascular and Endovascular Surgery at the Brigham and Women’s Heart & Vascular Center provide specialized diagnostic services to identify TOS as well as proven medical and surgical techniques designed for thoracic outlet syndrome treatment.
Thoracic outlet syndrome can come in one of three types, all impacting different locations within the thoracic outlet. The nerves are most often affected as much as 95% of the time. Veins and arteries can also be affected by TOS. In each situation, the thoracic outlet gets compressed.
There are three types of thoracic outlet syndrome:
Thoracic outlet syndrome causes range from an injury to poor posture. When the nerves, arteries and veins in the thoracic outlet get compressed, it can lead to TOS. The compression can come from a mix of injury types—sudden or repetitive—or be brought upon by several other situations, sometimes genetic and other times environmental. Some of the more common thoracic outlet syndrome causes:
Can Poor Posture Cause Thoracic Outlet Syndrome?
The ramifications of poor posture extend to the thoracic outlet. Poor body alignment compresses the thoracic outlet between the collarbone and rib cage, limiting the space for nerves, arteries and veins. A drooping shoulder can also result in thoracic outlet syndrome.
Symptoms of TOS vary depending upon whether the compression is related to nerves, arteries or veins. Differing types of thoracic outlet syndrome can yield symptoms of TOS anywhere from the neck and shoulder down through the arm and hand to the fingers. Patients may experience a mix of types of TOS syndrome, resulting in additional symptoms.
Nerve-related thoracic outlet syndrome symptoms:
Vein or artery-related thoracic outlet syndrome symptoms:
Does Thoracic Outlet Syndrome Cause Fatigue?
Pain is the leading thoracic outlet syndrome symptom, but arm fatigue can also present as a symptom, especially during activity.
Your vascular surgeon will often work in conjunction with a neurologist to evaluate your symptoms. Tests for thoracic outlet syndrome begin with a patient's medical history and a physical examination—including mobility testing—to understand pain points and determine if there is discoloration or swelling. Testing for thoracic outlet syndrome can include several diagnostic tests meant to rule out other conditions and pinpoint the location of the compression. When determining how to diagnose thoracic outlet syndrome, your health care provider may use a combination of tests and images in order to obtain the best results for diagnosis and treatment of thoracic outlet syndrome.
Common tests include:
What Other Conditions Does Thoracic Outlet Syndrome Mimic?
Thoracic outlet syndrome mimics other conditions due to the location of the pain. Other conditions that need to be ruled out may include angina (heart issues caused by inadequate blood supply), rotator cuff injuries, fibromyalgia, cervical disc disorders, multiple sclerosis and tumors.
Specific treatment for thoracic outlet syndrome varies depending on the type of TOS. Common strategies include physical therapy, pain medications, lifestyle changes, thrombolytic therapy and surgery.
Specialists from the Brigham and Women’s Heart and Vascular Center develop individualized treatment plans for patients based on:
Specific treatment varies depending on the type of TOS and may include:
Neurogenic Thoracic Outlet Syndrome Treatment
Arterial Thoracic Outlet Syndrome Treatment
Venous Thoracic Outlet Syndrome Treatment
When is Thoracic Outlet Syndrome Surgery Needed?
Thoracic outlet syndrome surgery is most common for arterial TOS but may be needed in other types, especially venous TOC. When physical therapy, medication and other therapies cannot relieve the compression or clotting in the thoracic outlet, surgery can create additional space in the area or repair blocked or damaged arteries and veins.
If you're at risk for TOS, you can prevent exacerbating thoracic outlet syndrome with a mixture of lifestyle changes.
The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham and Women’s main 75 Francis St. entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.
The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with thoracic outlet syndrome. After surgery, you will go to the post-surgical care unit, where you will receive comprehensive care from an experienced surgical and nursing staff.
During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.
Patients benefit from the teamwork of vascular and endovascular surgeons who collaborate with colleagues in other medical specialties. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.
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