The thoracic outlet is a small area between your collarbone, first rib and vertebra. This is a rigid space where many important structures are crowded together including blood vessels, nerves and muscles. Because they are in such a narrow space, compression of the nerves or vessels can occur, causing pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. This group of symptoms is known as thoracic outlet syndrome (TOS).
Thoracic outlet syndrome can be difficult to diagnose because a number of disorders have similar symptoms. It is important that you choose an experienced medical team to treat your TOS. The Lung Center at Brigham and Women’s Hospital (the Brigham) provides specialized diagnostic services for thoracic outlet syndrome, as well as proven techniques to relieve symptoms.
There are two common types of Thoracic Outlet Syndrome:
Compression of one or more of the veins or arteries under the collarbone
Risk Factors for Thoracic Outlet Syndrome:
The symptoms of thoracic outlet syndrome can vary, depending on the compressed structure (artery, nerve, or vein). Signs and symptoms of neurogenic/neurological thoracic outlet syndrome are:
Signs and symptoms of vascular thoracic outlet syndrome are:
Your medical team at The Lung Center will collaborate with a neurologist to evaluate your symptoms. Your medical team will perform a complete physical examination in order to find any outward signs of thoracic outlet syndrome, such as swelling or discoloration. In addition, your team may perform the following tests:
Surgery for patients who have an indication for surgery, the first rib or a part of the first rib is resected through a small incision in the armpit. This is done under general anesthesia:
Bypass surgery may be done to reroute blood around the compression or remove the area that is causing the symptoms. Your doctor may also suggest other alternatives, including angioplasty, if the artery is narrowed.
When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. You will receive a thorough diagnostic evaluation and receive clinically proven treatment by a BWH board-certified thoracic surgeon who specializes in thoracic outlet syndrome. This may include specialized physiologic tests, as well as imaging to examine the trapped vessel or nerve. Additionally, a psychological evaluation may be indicated.
Thoracic outlet syndrome patients benefit from the wide range of specialists at The Lung Center. Any surgery recommended will be performed by an experienced, board-certified thoracic surgeon, in collaboration with a treatment team that includes pulmonologists and neurologists, as well as nurses and physician assistants, all of whom specialize in caring for patients with thoracic outlet syndrome.
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