Thoracic Outlet Syndrome

Thoracic outlet syndrome develops when your blood vessels or nerves become compressed between your collarbone and first rib or neck. This may cause pain or make blood flow difficult. You might even find that your arm and hand become swollen and discolored or pale. You might also feel achy, tingly, or numb in your arm and hand and you might have difficulty finding a pulse in certain positions. At Mount Sinai, we have the expertise and sophisticated equipment to diagnose and treat this condition.

About Thoracic Outlet Syndrome

Thoracic outlet syndrome can become worse due weight lifting, obesity, pregnancy, chest tumors, or an extra rib near the base of the neck. Even poor posture—drooping shoulders or holding your head forward—can lead to thoracic outlet syndrome if the space around your arteries, nerves, or veins tightens.

Thoracic outlet syndrome tends to affect women more often than men. 

Diagnosis and Treatment

Our vascular experts perform several types of tests to make a diagnosis. We might use provocation tests to try to reproduce your symptoms, which can help us rule out other conditions that might cause similar symptoms. In addition, we often perform imaging tests, such as:

  • X-rays show if you have an extra rib or some other anatomical condition that is causing your symptoms.
  • Ultrasounds use sound waves to show what is happening in your body, which can help us see if you have a vascular problem.
  • Computerized tomography (CT) scans use X-rays and contrast dye to help us see your blood vessels in greater detail.
  • Magnetic resonance imaging (MRI) uses radio waves and magnets to help us see the location and cause of blood vessel compression.
  • Arteriography and venography involve using a thin tube (catheter) that we move through your arteries to the affected area. We use the catheter to inject dye, then take X-rays of the arteries or veins affected. We can also deliver medication to the spot using this catheter.

There are other tests that we can use to diagnose thoracic outlet syndrome and rule out other conditions that can cause similar symptoms:

  • Electromyography involves inserting a needle electrode to test the electrical activity of your muscles while they contract and are at rest.
  • Nerve conduction studies use a small amount of electrical current to test and measure how well your nerves send messages to muscles in different parts of your body; thoracic outlet syndrome can affect your body’s ability to send these messages.

We usually take a conservative approach to treatment, especially if we diagnose your condition early. We often use:

  • Physical therapy can strengthen and stretch your muscles to improve your range of motion and posture, which can then remove some of the pressure from your blood vessels.
  • Medication, such as anti-inflammatory, pain, or muscle relaxants, can help with your symptoms. We can also use clot-dissolving medication to dissolve blood clots and prevent new clots from forming.

We can also use thoracic outlet decompression if necessary. We have three approaches to this technique:

  • Transaxillary approach involves making an incision in your chest and removing a portion of your first rib, to decrease the pressure on your blood vessels.
  • Supraclavicular approach involves repairing the narrowed blood vessels by removing muscles and repairing blood vessels. We may also remove your first rib.
  • Infraclavicular approach can help us repair narrowed veins.

Sometimes we combine these techniques with reconstructive procedures of the arteries or veins.