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
Baylor Scott & White Advanced Heart Care - Idabel, OK
4 SE Avenue A , Idabel, OK, 74745
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 Cardiac Surgery - Longview
906 Judson Rd , Longview, TX, 75601
Baylor Scott & White Advanced Heart Failure Clinic - Longview
906 Judson Rd , Longview, TX, 75601
Baylor Scott & White Liver Consultants of Texas - Longview
906 Judson Rd , Longview, TX, 75601
- Monday: 8:30 am - 4:30 pm
- Tuesday: 8:30 am - 4:30 pm
- Wednesday: 8:30 am - 4:30 pm
- Thursday: 8:30 am - 4:30 pm
- Friday: 8:30 am - 4:30 pm
Baylor Scott & White Advanced Heart Care - Sulphur Springs
601 Airport Rd Ste 110, Sulphur Springs, TX, 75482
Baylor Scott & White North Texas Colon and Rectal Associates - Sulphur Springs
601 Airport Rd Ste 110, Sulphur Springs, TX, 75482
Baylor Scott & White Advanced Heart Failure Clinic - Tyler
1321 S Beckham Ave , Tyler, TX, 75701
Baylor Scott & White Center for Advanced Surgery - Tyler
1321 S Beckham Ave , Tyler, TX, 75701
Baylor Scott & White Center for Thoracic Surgery - Tyler
1321 S Beckham Ave , Tyler, TX, 75702
Baylor Scott & White Liver Consultants of Texas - Tyler
1321 S Beckham Ave , Tyler, TX, 75701
Baylor Scott & White North Texas Colon and Rectal Associates - Tyler
1321 S Beckham Ave , Tyler, TX, 75701
Baylor Scott & White Cardiac Surgery - Tyler
1321 S Beckham Ave , Tyler, TX, 75701
Touchstone Imaging Tyler
2019 Old Troup Hwy , Tyler, TX, 75701
Baylor Scott & White Texas Spine & Joint Hospital
1814 Roseland Blvd Ste 100, Tyler, TX, 75701
Glen Oaks Hospital
301 Division St , Greenville, TX, 75401
Baylor Scott & White Surgical Hospital - Sherman
3601 N Calais St , Sherman, TX, 75090
Baylor Scott & White Urgent Care+ Sherman
4028 N Hwy 75 , Sherman, TX, 75090
- Monday: 8:00 am - 8:00 pm
- Tuesday: 8:00 am - 8:00 pm
- Wednesday: 8:00 am - 8:00 pm
- Thursday: 8:00 am - 8:00 pm
- Friday: 8:00 am - 8:00 pm
- Saturday: 8:00 am - 5:00 pm
- Sunday: 8:00 am - 5:00 pm
Baylor Scott & White Texas Spine & Joint Hospital Urgent Care - Tyler
8101 S Broadway Ave , Tyler, TX, 75703
- Monday: 8:00 am - 8:00 pm
- Tuesday: 8:00 am - 8:00 pm
- Wednesday: 8:00 am - 8:00 pm
- Thursday: 8:00 am - 8:00 pm
- Friday: 8:00 am - 8:00 pm
- Saturday: 8:00 am - 6:00 pm
Baylor Scott & White Cardiology Consultants of Texas - Greenville
4400 Interstate 30 W Ste 300, Greenville, TX, 75402
- 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 - 5:00 pm
Baylor Scott & White Primary Care Associates - Greenville
4400 Interstate 30 W Ste 100, Greenville, TX, 75402
- 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 Primary Care Associates Pediatrics - Greenville
4400 Interstate 30 W Ste 110, Greenville, TX, 75402
- 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 Gastroenterology - Greenville
4400 Interstate 30 W Ste 300, Greenville, TX, 75402
Baylor Scott & White Orthopedic Associates of Dallas - Greenville
4400 Interstate 30 W Ste 300, Greenville, TX, 75402
Baylor Scott & White Imaging Center - Greenville
4400 Interstate 30 W Ste 200, Greenville, TX, 75402
- 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 Outpatient Rehabilitation - Greenville
4400 Interstate 30 W Ste 120, Greenville, TX, 75402
- 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 Endoscopy Center - Sherman
1615 US-75 Ste B, Sherman, TX, 75090
Sherman Endoscopy Center
1615 N Hwy 75 , Sherman, TX, 75090
Baylor Scott & White Women's Care & Continence Center - Sherman
260 E Evergreen St , Sherman, TX, 75090
- 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 - 5:00 pm
Baylor Scott & White Advanced Heart Care - Sherman Sycamore (Satellite)
203 E Sycamore St , Sherman, TX, 75090
Baylor Scott & White The Heart Group - Sherman
230 E Sycamore St Ste 205, Sherman, TX, 75090
Baylor Scott & White Arrhythmia Management - Sherman
230 E Sycamore St Ste 205, Sherman, TX, 75090
Baylor Scott & White Advanced Heart Care – Sherman Highland (Satellite)
300 N Highland Ave , Sherman, TX, 75092
Baylor Scott & White Digestive Diseases Group - Sherman
204 Medical Dr Ste 240, Sherman, TX, 75092
Baylor Scott & White Primary Care - Van Alstyne
250 N Collin McKinney Pkwy , Van Alstyne, TX, 75495
- 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 - 4:00 pm
Baylor Scott & White Institute for Rehabilitation - Anna
601 S. Ferguson Pkwy Ste 100, Anna, TX, 75409
Baylor Scott & White Institute for Rehabilitation - Royse City
594 W Interstate 30 , Royse City, TX, 75189
- Monday: 7:00 am - 7:00 pm
- Tuesday: 7:00 am - 7:00 pm
- Wednesday: 7:00 am - 7:00 pm
- Thursday: 7:00 am - 7:00 pm
- Friday: 7:00 am - 7:00 pm
Baylor Scott & White Advanced Heart Care - Anna
450 N Standridge Blvd , Anna, TX, 75409
Baylor Scott & White Digestive Diseases Group - Anna
450 N Standridge Blvd Ste 104, Anna, TX, 75409
Baylor Scott & White Texas Cardiac Associates - Royse City
6257 FM 2642 Blvd Ste 100, Royse City, TX, 75189
Baylor Scott & White Primary Care Associates - Royse City
6257 FM 2642 Blvd Ste 100, Royse City, TX, 75189
- 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 Surgical Institute - Royse City
6257 FM 2642 Blvd Ste 100, Royse City, TX, 75189
- Monday: 9:00 am - 5:00 pm
- Tuesday: 9:00 am - 5:00 pm
- Wednesday: 9:00 am - 5:00 pm
- Thursday: 9:00 am - 5:00 pm
- Friday: 9:00 am - 5:00 pm
Baylor Scott & White Institute for Rehabilitation - McKinney Red Bud
1705 W University Dr Ste 119, McKinney, TX, 75069
Baylor Scott & White Institute For Rehabilitation - McKinney Lake Forest
1705 W University Dr Ste 119, McKinney, TX, 75069
Baylor Scott & White Institute For Rehabilitation - McKinney University
1705 W University Dr Ste 119, McKinney, TX, 75069
Heritage Eye Center
1501 Redbud Blvd , McKinney, TX, 75069
Baylor Scott & White The Heart Hospital - McKinney
5268 W University Dr , McKinney, TX, 75071
The Laser Surgery Center, LLC
2600 W University Dr Ste 200, McKinney, TX, 75071
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February 25, 2025