Thoracic outlet syndrome is most commonly caused by the compression of the nerves to the arm.

Thoracic outlet syndrome 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 thoracic outlet syndrome:

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

Causes of thoracic outlet syndrome

Thoracic outlet syndrome can be caused by a variety of factors. Each type of thoracic outlet syndrome has a different cause:

  • Neurogenic thoracic outlet syndrome often has no specific cause but develops insidiously
  • Venous thoracic outlet syndrome may be caused by repetitive or strenuous use of the arm and shoulder
  • Arterial thoracic outlet syndrome 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 thoracic outlet syndrome is that it leads to blood clots that can block the circulation to your hand.

Symptoms of thoracic outlet syndrome

  • Neurogenic thoracic outlet syndrome – Symptoms include pain, numbness and weakness in your arm or hand
  • Venous thoracic outlet syndrome – Symptoms include swelling, dark discoloration of the arm and neck pain. Patients with this type of thoracic outlet syndrome often are diagnosed with a deep vein thrombosis in the arm.
  • Arterial thoracic outlet syndrome – Symptoms include pain, discoloration, and coldness in the hand

Why choose Ohio State for thoracic outlet syndrome treatment?

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.

How Ohio State diagnoses thoracic outlet syndrome

Each type of thoracic outlet syndrome 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

How Ohio State treats thoracic outlet syndrome

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

Medication

  • Neurogenic thoracic outlet syndrome – 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 thoracic outlet syndrome – 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 thoracic outlet syndrome – Cannot be treated with medication

Surgery

  • Neurogenic thoracic outlet syndrome – If your condition interferes with daily living activities and does not improve with medication and therapy, your physician may recommend surgery. Thoracic outlet syndrome decompression surgery involves removing certain muscles from your neck or removing your first rib, and sometimes it is necessary to remove both.
  • Venous thoracic outlet syndrome – 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 thoracic outlet syndrome – Surgery is the only treatment option for arterial thoracic outlet syndrome. 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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