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Thoracic Outlet Syndrome

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The blood vessels and nerves that run to your arms are located right below your collar bone in an area called the thoracic outlet. When there is pressure against one of these blood vessels or nerves, it can cause problems in your arms and hands, and is known as thoracic outlet syndrome.

Why Choose The Ohio State University Wexner Medical Center?

Since The Ohio State University Wexner Medical Center is an academic medical center, our patients benefit from innovative research, a depth of medical expertise and the newest technologies and treatment techniques available.

Thoracic outlet syndrome is a relatively rare condition, and requires expert care. As a large referral hospital, Ohio State's vascular surgeons have extensive experience diagnosing and treating these conditions.

What Is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome (TOS) occurs when there is pressure against the blood vessels or nerves in your thoracic outlet area that causes you to experience symptoms in your arms and hands. There are three types of TOS:

  • Neurogenic TOS – Caused by compression of the nerves to the arm. It makes up about 95 percent of all TOS cases. Symptoms include pain, numbness and weakness in your arm or hand.
  • Venous TOS – Caused by obstruction of the main vein (subclavian vein) to the arm. It makes up about three to four percent of all TOS cases. Symptoms include swelling, dark discoloration of the arm, and neck pain. Patients with this type of TOS often are diagnosed with a Deep Vein Thrombosis in the arm.
  • Arterial TOS – Caused by disease in the artery to the arm (subclavian artery). Arterial TOS is very rare, making up only one percent of all TOS cases. Symptoms include pain, discoloration, and coldness in the hand.

What Causes Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome can be caused by a variety of factors. Each type of TOS has a different cause:

  • Neurogenic TOS often has no specific cause but develops insidiously.
  • Venous TOS may be caused by repetitive or strenuous use of the arm and shoulder.
  • Arterial TOS is caused by a narrowing of the main artery to the arm.

Almost all arterial thoracic outlet syndrome cases occur as a secondary effect of having a congenital extra rib (cervical rib) or an abnormal first rib. The danger with arterial TOS is that it leads to blood clots that can block the circulation to your hand.

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Diagnosis of Thoracic Outlet Syndrome

Each type of TOS is diagnosed differently. After learning about the symptoms you are experiencing, your physician will know which physical examination to perform. In addition to an examination, your physician may order one of the following diagnostic tests:

  • Angiogram – An X-ray of blood vessels to identify blockage; it is performed by inserting a tube into an artery in the leg and injecting a contrast dye into the artery.
  • CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produce detailed images of the body, including bones, muscles, fat and organs.
  • Doppler ultrasound – A non-invasive diagnostic test that uses high-frequency sound waves to determine the speed and direction of blood flow in the heart. It is helpful in indicating the presence of a blockage in an artery or vein, or even within the heart.
  • MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of organs and structures inside the body.
  • Nerve conduction velocity test – A procedure that tests the speed of electrical signals through a nerve.
  • Venography – A test performed by injecting a radiographic material into a vein on the top of your foot. The material mixes with blood and flows toward your heart. An X-ray of your leg and pelvis will show any blockages in the calf and thigh veins.
  • X-rays of the neck or shoulder – A radiograph or picture of the neck or shoulder, including blood vessels, ribs and bones.

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Treatment of Thoracic Outlet Syndrome

Treatment of thoracic outlet syndrome varies greatly. The type of TOS you have will determine your treatment options.


  • Neurogenic TOS – Normally treated with physical therapy, such as stretching and neck strengthening exercises. Muscle relaxers, anti-inflammatory drugs and pain relievers may be prescribed in addition to the physical therapy.
  • Venous TOS – May be treated with clot dissolving medication (thrombolysis) or anticoagulants (blood thinners). The goal is to dissolve clots and keep new clots from forming.
  • Arterial TOS – Cannot be treated with medication.


  • Neurogenic TOS – If your condition interferes with daily living activities and does not improve with medication and therapy, your physician may recommend surgery. TOS decompression surgery involves removing certain muscles from your neck or removing your first rib, and sometimes it is necessary to remove both.
  • Venous TOS – The blood clot may need to be removed surgically from your vein. If the vein has been badly damaged, it may need to be repaired.
  • Arterial TOS – Surgery is the only treatment option for arterial TOS. The surgeon must repair or replace your damaged artery and remove your abnormal rib in order to prevent damage from recurring.

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Ohio State Medical Center Physicians Who Treat This Condition

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