Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome

Thoracic Outlet Syndrome is when the nerves and/or blood vessels of the thoracic outlet — the area where the shoulder meets the neck —are compressed by ribs, the collarbone, or neck muscles.

There are many bones, muscles, arteries, veins, and nerves in this area, and problems can arise if these structures compress each other.

There are different types of TOS depending on which structures are compressed:

  • Neurogenic Thoracic Outlet Syndrome (NTOS): The most common (85-90%) type of TOS, caused by compression and irritation of the brachial plexus, a network of nerves that connects to the arm and hand. We will primarily focus on NTOS.
  • Venous Thoracic Outlet Syndrome (VTOS): The next most common type of TOS, caused by compression of a vein.
  • Arterial Thoracic Outlet Syndrome (ATOS): The rarest type of TOS, caused by compression of an artery.

Visit TOS Education for an excellent resource for patients with Thoracic Outlet Syndrome

What Causes Thoracic Outlet Syndrome?

Thoracic outlet syndrome has multiple causes and risk factors. It is common among athletes involved in sports that require repetitive arm or shoulder movement such as baseball, swimming, and volleyball.

Trauma or injury to the neck or back can also cause thoracic outlet syndrome. It can also be caused by a cervical rib, which is an extra first rib that attaches to the 7th cervical vertebra. Additionally, thoracic outlet syndrome is more common in women than men.

What Are the Symptoms of Thoracic Outlet Syndrome?

Symptoms of neurogenic thoracic outlet syndrome include:
  • Pain
  • Numbness
  • Weakness or impaired circulation in the shoulder or arm
  • Patients also may experience increased pain when raising their arms.
Left untreated, TOS can also lead to muscle atrophy. It is important for Dr. Jenkins to rule out other neurological conditions that may present with similar symptoms.

How is Thoracic Outlet Syndrome Treated?

Dr. Jenkins will consider a patient’s history, overall condition, and severity and duration of the symptoms to come up with a unique treatment strategy for each patient. A treatment plan is often created based on which specific structures are actively compressing or irritating the brachial plexus or other structures, so an imaging study of the neck and shoulder region is necessary.

Typically, the first line of treatment for thoracic outlet syndrome includes conservative measures such as physical therapy. However, for those who require surgery, Dr. Jenkins has developed a minimally invasive surgical approach for the treatment of Thoracic Outlet Syndrome. We recently published a paper on this new approach, which you can read here.



Dr. Jenkins Discusses Why Diagnosing Thoracic Outlet Syndrome is So Difficult