Pronounced: tho-RASS-ik OUT-let SYN-drome
The thoracic outlet is the area of the lower neck and upper chest. This area has a variety of nerves, blood vessels, muscles and bones that run through a fairly small area. When the nerves and blood vessels of this area are compressed, irritated or injured they can cause a range of symptoms known as the thoracic outlet syndrome (TOS).
Thoracic Outlet Syndrome
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Compression, injury, or irritation of nerves and blood vessels can be caused by:
Factors that may increase your chance of developing TOS include:
TOS may cause the following:
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
During an elevated arm stress test, your doctor will ask you to hold your arms and head in positions that may cause the TOS symptoms to reappear. The results of these tests will help determine whether you have TOS and rule out other possible related conditions.
Other tests may include:
Images of internal body structures may be taken with:
Treatment varies depending on your specific symptoms. In most cases, TOS is managed with pain medication and physical therapy.
Your doctor may recommend the following:
A physical therapist will design some some exercises for you. The exercises will help to relieve symptoms by relaxing nearby muscles, improving posture and reducing pressure on nerves and blood vessels.
As part of your treatment, you may need to make lifestyle changes. Some of these may include:
If other treatments fail, your doctor may recommend surgery. The goal of surgery is to move or remove the source of the compression. In some people, this may involve removing part or all of the first rib to make more room for the nerves and blood vessels.
Occupational Safety & Health Administration
The Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT)
Canadian Centre for Occupational Health and Safety (CCOHS)
Public Health Agency of Canada
Crotti FM, Carai A, Carai M, et al. TOS pathophysiology and clinical features. Acta Neurochir Suppl . 2005;92:7-12.
Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery . 2004;55:897-902.
Nord KM, Kapoor P, Fisher J, et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyography Clinical Neurophysiology . 2008;48:67-74.
Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc. Surg . 2007;46:601-604.
Thoracic outlet syndrome. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00336 . Updated January 2011. Accessed July 19, 2013.
Thoracic outlet syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 21, 2013. Accessed July 19, 2013.
Thoracic outlet syndrome. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/thoracic/thoracic.htm . Updated December 28, 2011. Accessed July 19, 2013.
Wehbe M, Leinberry C. Current trends in treatment of thoracic outlet syndrome. Hand Clin . 2004;20:119-121.
Last reviewed July 2013 by Rimas Lukas, MD; Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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