Treatment of Thoracic Outlet Syndrome (TOS)

The subclavian artery and vein and the nerve roots of the brachial plexus pass through the area between the neck and shoulder and can be compressed by the first rib and the surrounding scalene muscles connecting the rib to the neck vertebrae. Clinically significant compression of the brachial nerves and subclavian vein are much more common than arterial involvement (<5%).

Symptoms of neurogenic TOS include pain, abnormal sensation and weakness of the hand or arm, sometimes extending to the shoulder, neck and upper back. Headaches and vasomotor symptoms may also commonly be associated. Diagnosis is multimodality, involving both imaging studies and neurophysiologic testing.

Treatment is almost always successful with physical therapy. Venous TOS is symptomatic for sudden onset of upper extremity swelling and pain. Duplex ultrasound is the primary means of diagnosis, and treatment often involves thrombectomy or thrombolysis, followed by surgical or endovascular correction of the underlying anatomic abnormality.