Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a term used to describe symptoms arising from compression of either the subclavian artery that supplies blood to the head and arms, and passes beneath the clavicle (arterial TOS); the subclavian vein (venous TOS); or brachial plexus, a group of spinal nerves emerging from the neck and leading into the arms (neurogenic TOS). Symptoms of TOS include pain in the neck and shoulder areas and numbness in the arm and hand.

Although arterial and venous TOS are well-recognized entities, they account for less than 5% of patients with the condition. By far, the majority of patients with this diagnosis have neurogenic TOS. The diagnosis of TOS is established based on symptoms, physical examination, imaging studies such as MRI and EMG, and nerve conduction studies.

Surgical Treatment

Some patients with TOS require surgery for relief of their symptoms. All patients with neurogenic TOS are first prescribed physical therapy to increase motion in the neck and shoulders, strengthen muscles, and improve posture. Only those whose severe symptoms persist after physical therapy are considered eligible for surgery.

Depending on symptoms and which structures are involved, TOS surgery can be performed by either a supraclavicular or transaxillary approach. While some surgeons who perform TOS surgery only have experience and expertise with one approach, surgeons at NewYork-Presbyterian/Columbia tailor the approach to TOS based on symptoms. In patients who have venous compression such as in Pagett-Schroeder syndrome, our surgeons favor a transaxillary decompression, whereas in arterial compression they favor a supraclavicular approach. In patients with neurogenic TOS our surgeons select the approach based on several patient factors. This affords the best results in patients with TOS.