Thoracic Outlet Syndrome
What is thoracic outlet syndrome (TOS)?
TOS is the name given to a group of symptoms caused when the nerves or blood vessels that travel between the collarbone and the first rib get compressed. The symptoms experienced will depend on if it is a nerve, vein or artery that is involved.
The first rib, collarbone and scalene muscles form a triangle in the neck. Sometimes, there is not enough space for the nerves and blood vessels to travel through this space freely. This can be due to a number of reasons including: an extra rib, trauma, poor posture, repetitive injuries and pregnancy.
Symptoms of TOS:
Neurogenic TOS (nerve compression) is the most common form of TOS (85%) and can present with the following symptoms:
- Muscle wasting in the fleshy base of the thumb (Gilliatt-Sumner hand)
- Numbness or tingling in the arm or fingers
- Pain or aches in the neck, shoulder or hand
- Weakening grip
Venous TOS (vein compression) accounts for around 10% of TOS and can present with:
- Sudden swelling of the entire arm
- Bluish discoloration of the arm
- Heaviness of the arm
- Arm pain
Arterial TOS (artery compression) is the rarest form of TOS (5%) and can present with:
- Sudden onset of hand pain and weakness
- Numbness and tingling in the hand or fingers
- Cold and pale fingers
- Chronic arm fatigue
- Arm pain during activity (claudication)
- Non-healing wounds or ulcerations in the fingers
If TOS is suspected based on symptoms and a physical examination, further investigation will be done to confirm if TOS is the cause.
This can include: Xray, ultrasound scan, CT scan with dye to look at vessels, MRI, angiogram/venogram.
Your GP or surgeon will be able to advise which of these investigations is necessary
Treatment of TOS:
In some cases, there are non-surgical options for treatment of TOS, such as physiotherapy and medications. If this approach is not successful, or if your particular condition is not suitable for non-surgical management, there are surgical treatment options that we offer at VCC.
First Rib Resection:
This is the mainstay of surgical management for all types of TOS. This serves to remove one side of the ‘triangle’ that is compressing the nerves or vessels, allowing them to pass freely through the neck. This is done under general anaesthetic, by making an incision above or below the collarbone. You can expect to spend 2-3 nights in hospital following this procedure and have approximately 2 weeks off work.
Occasionally, an additional procedure may be required at the same time as a first rib resection. Your surgeon will discuss this with you if it is needed for you.