Many health conditions can cause pain, tingling, or numbness in your neck, chest, arms, and hands, from minor muscle strains to a serious problem like a heart attack.
While thoracic outlet syndrome (TOS) is not life-threatening, it can lead to disability and complications if left untreated.
Find out about the types of TOS, common symptoms, and who is at risk.
What is Thoracic Outlet Syndrome?
The thoracic outlet is the space where arteries, veins, and nerves travel through the upper chest. TOS describes a group of conditions that occur when these blood vessels or nerves are compressed.
TOS most often affects:
- Athletes who participate in activities with repetitive overhead motion (pitchers, swimmers, volleyball players, tennis players, weightlifters).
- Jobs with repetitive overhead activity (pharmacists, electricians).
- People with previous neck trauma, shoulder injuries or a broken collarbone.
- Teenagers.
Anyone of any age and gender may develop TOS, and it’s generally more common in women than men.
Thoracic Outlet Syndrome Types and Causes
Neurogenic thoracic outlet syndrome
- Most common type, representing more than 90% of TOS patients.
- Caused by compression of the brachial plexus – the network of nerves in the thoracic outlet – often due to a previous injury, trauma, or repetitive motions .
Venous thoracic outlet syndrome
- Caused by compression of the subclavian vein– which brings blood from your arm back to your heart – possibly due to repeated strenuous use of the shoulder and arm.
Arterial thoracic outlet syndrome
- Least common type.
- Caused by compression of the subclavian artery – which provides blood to the arm – possibly due to an abnormal or extra first rib.
Thoracic Outlet Syndrome Symptoms
Symptoms of this condition can depend on which type of TOS you have.
Neurogenic thoracic outlet syndrome
- Arm/hand fatigue, numbness, tingling.
- Headaches in the back of the head.
- Neck pain.
- Pain from shoulder to fingertips.
Venous thoracic outlet syndrome
- Arm fatigue, heaviness, and swelling.
- Blue discoloration.
- Dilated veins in arm and chest.
Arterial thoracic outlet syndrome
- Arm/hand coolness or fatigue.
- Cold intolerance.
- Cramping.
- Discoloration of the fingernail bed.
Thoracic Outlet Syndrome Treatment
Treatment options depend on the type of TOS. In all cases, early diagnosis is helpful and improves outcomes. The goals of treatment are alleviating your symptoms and improving your quality of life.
Arterial TOS often requires the greatest need for surgical repair due to the risk of blood clots migrating to the arm and hand. Early medication may be needed to dissolve clots, and additional imaging is routinely used to determine if the subclavian artery needs to be repaired or replaced.
Venous TOS also is initially managed with clot-dissolving medication to lower the risk of pulmonary emboli. Once the clot has been effectively treated, your surgeon may discuss removing the first rib and a muscle before repairing the narrowed vein to prevent future recurrence.
Only 20% to 30% of neurogenic TOS patients require surgery. It is routinely managed with physical therapy focusing on posture reconditioning, shoulder and neck range of motion, and strengthening core back muscles. Patients who don’t respond to these treatments may require removal of ribs or muscles that are compressing the nerves.
Surgery is highly effective for alleviating symptoms and providing durable results for arterial and venous TOS. Neurogenic TOS surgery can be very effective, but it is associated with a 22% rate of recurrence in the lifetime of the patient due to the chronic repetitive nature of an individual’s occupation.
Editor's Note: This article was originally published on , and was last reviewed on .