Thoracic outlet syndrome occurs when there is pressure against the blood vessels or nerves in your thoracic outlet. The thoracic outlet is the space between your collarbone and your first rib—the lower neck and upper chest area. This pressure causes you to experience various 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, this type comprises about 95% of all thoracic outlet syndrome cases.  
  • Venous thoracic outlet syndrome: Caused by obstruction of the main vein (subclavian vein) to the arm, this type comprises about 3 – 4% of all thoracic outlet syndrome cases.  
  • Arterial thoracic outlet syndrome: Caused by disease in the artery to the arm (subclavian artery), this type is very rare and comprises only 1% of all thoracic outlet syndrome cases.

Thoracic outlet syndrome causes

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 gradually over time. 
  • 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 being born with an 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

The symptoms you may experience are determined by the type of thoracic outlet syndrome you have: 

  • 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 also have deep vein thrombosis in the arm. 
  • Arterial thoracic outlet syndrome – Symptoms include pain, discoloration and coldness in the hand.

Diagnosis of thoracic outlet syndrome

Our team uses different tests to diagnose the different types of thoracic outlet syndrome. After learning about the symptoms you’re 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, CT scan, Doppler ultrasound, MRI, nerve conduction velocity test, venography or X-rays.

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Treatment

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 – Your specialist may prescribe physical therapy, which includes stretching and neck-strengthening exercises. Your specialist may also prescribe muscle relaxers, anti-inflammatory drugs and pain relievers in addition to the physical therapy. 
  • Venous thoracic outlet syndrome – Your specialist may prescribe clot-dissolving medication (thrombolysis) or anticoagulants (blood thinners). The goal is to dissolve clots and keep new clots from forming. 
  • Arterial thoracic outlet syndrome – This type can’t 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’s necessary to remove both. 
  • Venous thoracic outlet syndrome – Your surgeon may need to remove the blood clot surgically from your vein. If the vein has been badly damaged, your surgeon may need to repair it. 
  • 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.

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, close to home in Columbus.

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