Thoracic Outlet Syndrome

There are three main types of thoracic outlet syndrome. Each type affects a different structure in the thoracic outlet and may require different treatment approaches.

Neurogenic Thoracic Outlet Syndrome

Neurogenic thoracic outlet syndrome, sometimes called neurogenic TOS, is the most common form and accounts for approximately 90-95% of cases. This type of TOS occurs when a cluster of nerves near your collarbone, called the brachial plexus, become compressed.

Neurogenic TOS symptoms often include numbness, tingling, weakness in the hand or arm, shoulder pain and reduced grip strength. These symptoms can worsen with repetitive movements or certain arm positions.

Venous Thoracic Outlet Syndrome

Venous thoracic outlet syndrome occurs when veins in the thoracic outlet – the space between the collarbone – become squeezed, which can slow or block blood flow returning from the arm to the heart.

Venous TOS symptoms may include arm swelling, heaviness, discoloration and bulging veins in the shoulder or chest. In some cases, venous TOS causes blood clots that require prompt medical attention.

Arterial Thoracic Outlet Syndrome

Arterial thoracic outlet syndrome is the least common type of TOS, but it can be the most serious. It occurs when an artery is compressed, reducing blood flow to the arm and hand.

Symptoms of arterial or vascular TOS can include sensitivity to cold, pale or bluish skin, hand pain and a weakened pulse in your affected arm.

Thoracic Outlet Syndrome

The treatment for TOS depends on the severity of your symptoms, the type of TOS you have and the underlying cause of compression. Many people improve with nonsurgical treatment, while others may benefit from minimally invasive thoracic outlet surgery to relieve pressure on nerves or blood vessels.

Nonsurgical Treatment

For many people, nonsurgical TOS treatment is the first step in getting relief. Treatment plans often focus on improving posture, strengthening muscles and reducing pressure within the thoracic outlet.

Nonsurgical thoracic outlet syndrome treatment options may include:

• Activity modifications to reduce repetitive strain
• Anti-inflammatory medications such as aspirin, ibuprofen, or naproxen
• Blood clot prevention or medications for vascular TOS
• Pain management strategies
• Physical therapy focused on posture correction and muscle balance

Physical therapy is often especially helpful for neurogenic TOS and may significantly reduce symptoms over time.

Surgical Treatment

Thoracic outlet surgery may be recommended when symptoms do not improve with conservative treatment or when blood vessel compression causes serious complications. The most common TOS surgery is called first rib resection for thoracic outlet syndrome.

During a first rib resection, surgeons remove part of the first rib or surrounding tissue that is causing compression. At OSF HealthCare, this procedure is performed using minimally invasive, robotic-assisted techniques. Robotic thoracic outlet surgery allows surgeons to operate with greater precision through smaller incisions.

First rib resection surgery typically takes about 90 minutes. Many patients return home the same day or after an overnight stay, and most people experience relief from their symptoms and a quicker recovery when compared to traditional surgery.

Our Multidisciplinary Approach to TOS Care

Thoracic outlet syndrome often requires care from several medical specialties because the condition can affect your nerves, arteries or veins. At OSF HealthCare, you benefit from a coordinated, multidisciplinary approach to TOS care.

Your care team may include:

• Orthopedic specialists
• Neurologists
• Pain management providers
• Physical medicine and rehabilitation specialists
• Physical therapists
• Thoracic surgeons
• Vascular surgeons

Our specialists work together to create individualized care plans based on the type of thoracic outlet syndrome and your unique TOS symptoms.

Why Choose Us for Your Care

At OSF HealthCare, our providers have specialized training and experience in diagnosing and treating complex thoracic outlet conditions. We're continually expanding access to advanced thoracic outlet syndrome treatments to ensure we offer the best options for alleviating the pain and discomfort of TOS.

You benefit from:

• Advanced imaging and thoracic outlet syndrome testing to accurately diagnose TOS
• Access to innovative surgical techniques close to home
• Access to minimally invasive thoracic outlet surgery options
• Personalized treatment plans designed to improve comfort, function and recovery