If you experience pain, numbness or tingling in your neck, shoulder, arm or hand, it may be a sign of thoracic outlet syndrome (TOS). This condition happens when nerves or blood vessels get squeezed or compressed in your upper chest.
At Banner Health, we can help you find answers and relief. Our experts are trained to diagnose and treat all types of thoracic outlet syndrome, ranging from mild to more severe cases. Learn more about the symptoms, causes and treatment options for TOS and how we can help you.
The thoracic outlet is the space between the collarbone and the first rib at the top of the rib cage. Thoracic outlet syndrome (TOS) refers to a group of disorders caused by compression of nerves or a vein or artery in this area.
Usually, nerves and blood vessels pass through the thoracic outlet easily. When they are squeezed, other structures in your chest (such as bones, muscles or scar tissue) put pressure on this space. This can lead to symptoms, including pain, swelling, tingling or weakness in your neck, shoulder, arm or hand.
Neurogenic thoracic outlet syndrome (nTOS) accounts for more than 90% of all thoracic outlet syndrome cases. It happens when the brachial plexus (a group of nerves that runs from the neck to the arm) is compressed in the thoracic outlet space. This compression can lead to pain, numbness, and muscle weakness.
Common symptoms of neurogenic TOS include:
Neurogenic TOS can develop gradually or after an injury like whiplash or a repetitive strain. Left untreated, it may lead to chronic pain or muscle wasting in the hand.
While neurogenic TOS is the most common form, there are other types of thoracic outlet syndrome that affect blood vessels. These types are less common but may be more urgent or serious.
This type affects a large vein that carries blood out of your arm, known as the subclavian vein. This vein carries blood from your arm back to the heart. About 5% of cases are venous TOS.
Arterial TOS is the rarest but most serious type. Only 1% of cases are arterial. It happens when an artery that carries blood to your arm (the subclavian artery) is squeezed. Compression of the arterial TOS can reduce blood flow to the arm and hand.
When both the subclavian vein and artery are compressed, the condition is sometimes referred to as vascular TOS. These cases may require more immediate medical attention and often involve imaging tests and surgery.
Risk factors for developing TOS vary depending on the type. Common causes include:
In some cases, experts don’t know exactly what causes TOS. The onset of symptoms may develop over time due to a combination of factors.
Symptoms of TOS depend on the type you have, but they often include:
Symptoms may come and go or they may get worse with activity. Some people experience pain after raising their arms, carrying heavy objects or sitting for long periods.
Contact a Banner Health specialist if you are experiencing pain or discomfort.
There is no single test for TOS. Your health care provider will start by asking about your symptoms and medical history. They will also perform a physical exam to check your strength, feeling and blood flow.
You may also need:
These tests help rule out other conditions like carpal tunnel syndrome and confirm the type of TOS you have so your provider can create the best treatment plan.
Treatment varies depending on the type of TOS and how severe symptoms are. Neurogenic TOS is the most common and is often treated without surgery. Other types, like venous and arterial TOS, may need more urgent intervention, especially if blood flow is reduced. Many people start with conservative treatment. Surgery is considered if symptoms don’t improve.
Conservative treatment is especially effective for nTOS and is often the first step in care. These treatments may include:
Surgery is more common in people with arterial TOS, vTOS or nTOS that don’t respond to other treatments. The type of surgery depends on what is causing the problem.
Your surgeon may:
Banner Health surgeons use advanced, minimally invasive techniques to help you heal faster and reduce complications. Talk with a Banner Health specialist to learn more about surgical options.
Without treatment, TOS can lead to permanent nerve damage, chronic pain, muscle loss or blood clots. Serious but rare complications include pulmonary embolisms (blockage in an artery) or aneurysms (abnormal bulging of the artery).
With early treatment, most people feel better and return to normal life. After surgery, physical therapy helps to regain strength and mobility. Your health care provider may recommend follow-up visits to monitor your healing and ensure your ongoing health.
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