Thoracic Outlet Syndrome | Baylor Scott & White Health

What is thoracic outlet syndrome?

Thoracic outlet syndrome (TOS) refers to a group of symptoms that affect your neck, arm and hand. It occurs when nerves or blood vessels in part of the upper chest, known as the thoracic outlet, are compressed.

The thoracic outlet is a narrow space located between your collarbone and first rib. If an injury, abnormal bone or muscle, or another factor reduces the space further, it puts pressure on your nerves, an artery or a vein.

Thoracic outlet syndrome is more common in women than men, and in most cases, it develops between the ages of 20 and 50.

This condition can affect your quality of life in a variety of ways. Pain, weakness or swelling in your arm or hand can reduce your ability to play sports or perform everyday tasks. With help from an experienced heart and vascular team, you can minimize symptoms and get back to feeling like you.

women dealing with thoracic outlet syndrome sitting at her desk

Types of thoracic outlet syndrome

There are three types of this condition. Physicians classify thoracic outlet syndrome based on whether nerves or blood vessels are compressed.

Neurogenic thoracic outlet syndrome

Neurogenic thoracic outlet syndrome (NTOS) is when the nerves in your thoracic outlet become compressed.

Venous thoracic outlet syndrome

Venous thoracic outlet syndrome (VTOS) is a condition where a vein, typically the subclavian vein that takes blood from your arms and returns it to your heart, becomes compressed in the thoracic outlet.

Arterial thoracic outlet syndrome

Arterial thoracic outlet syndrome (ATOS) occurs when the subclavian artery, which supplies oxygen-rich blood to your arms, shoulders and brain, is compressed. This is the rarest type of thoracic outlet syndrome.

Thoracic outlet syndrome symptoms

The symptoms you experience depend on which of the three types of thoracic outlet syndrome you have.

Arterial thoracic outlet syndrome

The subclavian artery runs through the thoracic outlet. Pressure on this artery can limit blood flow into your arm, leading to symptoms that may include:

Abnormal color in your hand and fingers
Hand and fingers that feel cold or weak
Reduced range of motion
Swelling or numbness in your arm and hand

What causes thoracic outlet syndrome?

In some people, a physical abnormality can put pressure on the structures inside the thoracic outlet. One example is a cervical rib, an extra rib attached to the top of the spine. In other cases, an enlarged muscle in the neck called the scalene muscle can press on the nerves or blood vessels.

Other causes include:

Injury to the blood vessels
Overuse of the arm or shoulder from playing sports or other activities
Poor posture affecting the nerves
Pregnancy
Tumor pressing on the nerves

man dealing thoracic outlet syndrome on a porch deck stretching

How to diagnose thoracic outlet syndrome

To diagnose thoracic outlet syndrome, your provider will ask you about your medical history, perform a physical exam and may order some testing.

Physical exam and medical history

A variety of conditions, including rotator cuff injuries and problems with the discs at the top of the spine, can cause symptoms like those of thoracic outlet syndrome. As a result, your physician will want to gather as much information as possible to rule out other potential causes and definitively diagnose thoracic outlet syndrome.

Your physician will ask about your symptoms and how they’re affecting you. Next, they’ll conduct a physical exam to look for skin discoloration in the affected arm or hand and weakness in the hands or fingers.

During your exam, your physician may have you perform an elevated arm stress test. You’ll raise your arms above your head for several minutes and open and close your fists so your physician can see if symptoms occur.

Thoracic outlet syndrome treatment

Thoracic outlet syndrome is quite treatable. Your heart and vascular specialists will work with your primary care, neurology and orthopedic specialists to treat your condition, so you can feel better and get back to your active lifestyle without discomfort.

Lifestyle changes

There are several lifestyle changes you can implement to help with thoracic outlet syndrome, including:

Changes to your daily routine: Your physician or a physical therapist can help you modify or avoid activities that worsen symptoms. For example, you’ll want to avoid intense physical activity or activities that involve heavy weight pressing down on your shoulders, which can stress your collarbone.
Weight loss: Losing weight can help relieve strain on the shoulder muscles.

Find a location near you

Whether your physician has recommended conservative treatment or surgery for your thoracic outlet syndrome, you can find comprehensive care at our heart and vascular locations in North and Central Texas. We can coordinate your care at a location with the services you need.

Baylor Scott & White All Saints Medical Center - Fort Worth

1400 8th Ave , Fort Worth, TX, 76104

Baylor Scott & White All Saints Medical Center - Fort Worth

1400 8th Ave , Fort Worth, TX, 76104

What is thoracic outlet syndrome?

Types of thoracic outlet syndrome

Neurogenic thoracic outlet syndrome

Venous thoracic outlet syndrome

Arterial thoracic outlet syndrome

Thoracic outlet syndrome symptoms

Arterial thoracic outlet syndrome

What causes thoracic outlet syndrome?

How to diagnose thoracic outlet syndrome

Physical exam and medical history

Thoracic outlet syndrome treatment

Lifestyle changes

Find a location near you

Our Offerings

Tools and Resources

About us

Get Involved

For Medical Professional