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Thoracic Outlet Syndrome

What is thoracic outlet syndrome (TOS)?

Thoracic outlet syndrome (TOS) is a condition caused by compression of nerves or blood vessels in the thoracic outlet, the area between the base of the neck and the armpit, including the front of the shoulders and chest.

There are three types of TOS:

  1. Vascular. This can be a compression of the artery and vein.
  2. Neurogenic. The nerves become compromised from an extra cervical rib, present at birth.
  3. Disputed or painful form. There is no neurological deficit but patients experience neurological symptoms and pain. Typically these patients’ electrodiagnostic studies (EMG / NCV) are normal, but they complain of pain.

Causes of thoracic outlet syndrome (TOS)

Thoracic outlet syndrome is caused by an enlargement or change of the tissues in or near the thoracic outlet. Causes of enlargement of the tissues may include:

  • Trauma or injury
  • Weight lifting
  • Cervical rib (an extra rib extending from the neck present at birth)
  • Weight gain
  • Growth of a tumor

Often, there is no direct cause found in patients suffering from TOS.

Symptoms of thoracic outlet syndrome (TOS)

Thoracic outlet syndrome may include the following symptoms:

  • Neck, shoulder, and arm pain
  • Numbness in the arm, hand or fingers
  • Impaired circulation to the extremities (causing discoloration)
  • Weakness in the shoulders, arm and hands

Diagnosis of thoracic outlet syndrome (TOS)

Proper diagnosis of thoracic outlet syndrome requires the expert attention of experienced neurologists and nerve specialists.

Diagnosis will include:

  • A comprehensive clinical exam, including neurological exams
  • Complete medical history
  • Imaging studies such as X-rays and/or MRI (magnetic resonance imaging)
  • Electrodiagnostic studies (EMG)

Diagnosis is necessary to determine the cause of TOS, so the appropriate treatment plan, including a surgical option is considered.

Treatment for thoracic outlet syndrome (TOS)

Nonsurgical treatment for thoracic outlet syndrome

There are several forms of treatment for patients with TOS. These may include:

  • Physical therapy with careful nerve stretching movements performed by a qualified and experienced physical therapist with experience treating TOS.
  • Injections with nerve blocking agents to suppress pain and reduce swelling and compression.
  • Acupuncture. Some patients with TOS have found relief using acupuncture.

Surgery for thoracic outlet syndrome (TOS)

When physical therapy and other forms of non-surgical treatment fail, surgery is the best option to restore function and alleviate pain. Learn more about surgery for thoracic outlet syndrome (TOS).

Dr. Allan Belzberg is a world-renowned neurosurgeon in the treatment of peripheral nerve injuries. He treats on average 500 nerve injuries every year and has published research publications focusing on improving surgical repairs of nerve injuries and discovering new treatment options. Catch up on the latest research on nerve injuries.

To make an appointment or request a consultation, contact the Johns Hopkins Peripheral Nerve Surgery Center at 410-614-9923.

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Maryland Patients

To request an appointment or refer a patient, please contact the Johns Hopkins Peripheral Nerve Surgery Center at 410-614-9923.
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Adult Neurology: 410-955-9441
Pediatric Neurology: 410-955-4259
Adult Neurosurgery: 410-955-6406
Pediatric Neurosurgery: 410-955-7337


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