Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is an uncommon condition that can occur when the nerves and blood vessels coming from the spine or a major vessel of your body pass through a narrow area between the shoulder and armpit continuing down the arm. The narrowness of this channel can put pressure on the nerves and blood vessels, causing pain and weakness.

Specialists at The University of Kansas Health System in Kansas City are highly experienced in treating thoracic outlet syndrome and other types of vascular disease. Our team combines experience with leading-edge technology as well as access to academic research and clinical trials for the most advanced treatment options.

As the blood vessels and nerves pass the collarbone and upper ribs, there may not be enough space, which can cause pressure (compression). Thoracic outlet syndrome occurs when pressure on the nerves and vessels cause pain in the neck, shoulder, armpit and hand, leading to a weak grip.

Another cause of the compression can stem from having an extra cervical rib or an abnormal fibrous band between the spinal vertebra connecting to the rib. People with injuries to a shoulder or who overuse a shoulder are the ones who are most often affected with TOS.

Symptoms of thoracic outlet syndrome can include:

• A depression in your shoulder
• Aching in your neck, shoulder, arm or hand
• Hand weakness
• Limited range of motion of your arm
• Pain, numbness or tingling of your forearm or fingers
• Pain in your neck muscles
• Pale and cool arm and hand
• Swelling and redness of your arm

Several different risk factors can contribute to developing thoracic outlet syndrome:

• An abnormality in the neck muscles at birth
• Having an extra rib at birth
• Injury to the first rib or collarbone
• Neck injury
• Repetitive overhead arm movements that may cause inflammatory changes

To diagnose thoracic outlet syndrome, your doctor will perform a physical exam, including a detailed medical history that includes information about your symptoms. From there, imaging tests such as X-ray or MRI may be used to identify or rule out underlying conditions that could be contributing to your symptoms.

Once your physician has diagnosed thoracic outlet syndrome, physical therapy and/or surgery may be recommended. The types of surgery that are performed to correct TOS are:

• Bypass surgery, to reroute the blood
• Removal of a section of the first rib to relieve pressure
• Removal of the extra rib and some muscles