Thoracic Outlet Syndrome
Pronounced: tho-RASS-ik OUT-let SYN-drome
The thoracic outlet is the area of the lower neck and upper chest. This area has a variety of nerves, blood vessels, muscles and bones that run through a fairly small area. When the nerves and blood vessels of this area are compressed, irritated or injured they can cause a range of symptoms known as the thoracic outlet syndrome (TOS).
Compression, injury, or irritation of nerves and blood vessels can be caused by:
Factors that may increase your chance of developing TOS include:
TOS may cause the following:
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
During an elevated arm stress test, your doctor will ask you to hold your arms and head in positions that may cause the TOS symptoms to reappear. The results of these tests will help determine whether you have TOS and rule out other possible related conditions.
Other tests may include:
Images of internal body structures may be taken with:
Treatment varies depending on your specific symptoms. In most cases, TOS is managed with pain medication and physical therapy.
Your doctor may recommend the following:
A physical therapist will design some some exercises for you. The exercises will help to relieve symptoms by relaxing nearby muscles, improving posture and reducing pressure on nerves and blood vessels.
As part of your treatment, you may need to make lifestyle changes. Some of these may include:
If other treatments fail, your doctor may recommend surgery. The goal of surgery is to move or remove the source of the compression. In some people, this may involve removing part or all of the first rib to make more room for the nerves and blood vessels.
Occupational Safety & Health Administration
The Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT)
Canadian Centre for Occupational Health and Safety (CCOHS)
Public Health Agency of Canada
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Last reviewed July 2013 by Rimas Lukas, MD; Brian Randall, MD