What Is Thoracic Outlet Syndrome?

Thoracic outlet syndrome occurs when the blood vessels or nerves near the shoulder and upper ribs become compressed. The condition causes discomfort that’s difficult to ignore. 

There are three types: 

• Arterial: Compression affecting an artery between your collarbone and ribs
• Venous: Narrowing in the subclavian veins, which carry blood from your arm to your heart
• Neurogenic: Pressure on the bundle of nerves that supplies movement and feeling to your shoulders, arms and hands (brachial plexus)

Thoracic outlet syndrome (TOS) can make once-simple activities, like raising your arms, uncomfortable. But treatment from vascular disease experts at Virginia Mason Franciscan Health can help you get lasting relief. Our program has all the services you need, including precise testing and advanced therapies like thoracic outlet decompression. Meet our team.

Thoracic outlet syndrome symptoms may be ongoing. Some people experience them only when raising their arms above their head.

Common TOS symptoms include: 

• Bulging veins in your chest or arms
• Pain or a pins-and-needles sensation
• Redness or other skin discoloration
• Sensitivity to cold in the upper extremities
• Swelling
• Weakness or numbness

Arterial or venous TOS occurs when the subclavian artery or vein is squeezed as it passes through the thoracic outlet. This compression may cause blood clots to develop, limiting blood flow in your arm or hand. 

Neurogenic TOS is the most common type. It happens when the brachial plexus is compressed, typically from a sports injury.

Certain factors increase your risk for TOS, including: 

• Anatomical differences: You face a higher risk if you have an extra rib or unusually thick tissue in your neck, which can narrow the thoracic outlet.
• Posture: How you position your body when performing activities with your upper body can irritate tissue near the thoracic outlet.
• Pregnancy: During pregnancy, the body produces hormones that relax tissue near the spine, including the thoracic outlet.
• Trauma: A bad fall or car accident, especially one causing whiplash, can injure tissue near your thoracic outlet.
• Tumors: Unusual growths in the inner neck can narrow the thoracic outlet.
• Weight gain: Having obesity or engaging in activities that build neck muscle (like weightlifting) can cause narrowing in the thoracic outlet.

We conduct an exam to learn more about your symptoms. It may involve asking you to move your arms in specific ways to see whether your discomfort improves or worsens. Our doctors also consider other possible causes, like nerve issues. Your assessment will likely include duplex ultrasound and other vascular testing in our accredited lab.

The treatment that’s right for you depends on the type, cause and severity of TOS. We may recommend medications to relieve pain or dissolve blood clots. You may also benefit from physical therapy to improve poor posture or range of motion in your arms.

Surgery is often necessary to relieve pressure on the subclavian artery or vein. You may need thoracic decompression surgery, during which we remove sections of bone or soft tissue to create a wider opening in the thoracic outlet. We may also repair damaged blood vessels or remove blood clots.

Learn more about testing and treatment in the Puget Sound.