Thoracic Outlet Syndrome Program

Specialized Treatment for Thoracic Outlet Syndrome

If you’re living with the pain, tingling and weakness of your arm, or if you’ve been diagnosed with a vein blood clot in your arm, it’s time to get help. At UMass Memorial Health, our vascular surgeons specialize in diagnosing and treating these uncommon conditions, known as thoracic outlet syndromes (TOS). In fact, we’re one of only a few programs in the region with the ability to treat all types of TOS. You don’t have to travel far for comprehensive care from a skilled team. 

What Is Thoracic Outlet Syndrome? 

TOS describes a group of symptoms caused by compressed veins, arteries or nerves in your thoracic outlet, the space between your collarbone and first rib. TOS is usually the result of trauma, overuse injuries, tumors, or congenital conditions, such as rib abnormalities present at birth. 

There are three types of TOS: 

• Neurogenic thoracic outlet syndrome (compressed nerves)
• Venous thoracic outlet syndrome (compressed vein)
• Arterial thoracic outlet syndrome (compressed artery)

UMass Memorial Medical Center is home to one of only a few dedicated TOS programs in the region, providing care for all three forms of TOS.

Thoracic Outlet Syndrome Symptoms

TOS can cause a range of symptoms, including: 

• Pain or aching in your neck, shoulder, arm or hand
• Pain, numbness or tingling in your fingers
• Pale and cool arm and hand
• Swelling and discoloration of your arm
• Deep vein blood clot in the arm

Diagnostic Tests for Thoracic Outlet Syndrome

TOS can be difficult to diagnose. The symptoms are similar to those of other, more common conditions, such as rotator cuff injuries or cervical spine problems. That’s why it’s so important to see a specialist who routinely evaluates and treats TOS.

Our vascular experts review your medical history and symptoms and do a comprehensive physical exam. Next, they may recommend imaging exams or neurological tests to gather more information about your condition. Thoracic outlet syndrome tests may include: 

• Chest or cervical spine X-ray
• Duplex ultrasound

Thoracic Outlet Syndrome Treatment

Conservative treatments often ease TOS symptoms due to neurogenic TOS. We may recommend physical therapy, medication, changes to your daily activities or nerve blocks. If these are unsuccessful, surgery may be considered.

Venous and arterial TOS are not treated with physical therapy; surgery is often considered for these conditions. 

Regardless of the type of TOS, when surgery is recommended, the key step is to surgically remove the rib that is causing the compression. Depending on the type of thoracic outlet syndrome, there are additional steps that are also taken:

• For neurogenic TOS, the nerves must be freed from surrounding scar tissue.
• For venous TOS, the clot must be removed and the scarred portion treated. This can often be done with a minimally invasive procedure.
• For arterial TOS, the artery must be repaired or replaced surgically.