Thoracic Outlet Syndrome Care

Thoracic Outlet Syndrome Center

What is Thoracic Outlet Syndrome?

If you don’t know much about Thoracic Outlet Syndrome (TOS), you’re not alone.

Thoracic outlet syndrome (TOS) is not a common condition. Less than 2% of the population is diagnosed with some form of thoracic outlet syndrome. There is not a widespread understanding or recognition of the disease process, but below is a general overview.

Thoracic outlet syndrome refers to a collection of symptoms that occur when the blood vessels or nerves in the thoracic outlet (space between the collarbone and first rib) are compressed. This can cause a variety of symptoms depending on what structures are compressed.

It takes great expertise to determine whether a patient is suffering from TOS or something else. The symptoms often overlap with rotator cuff injuries, cervical disc disorders, cervical dystonia, fibromyalgia, multiple sclerosis, tumors of the spinal cord and other conditions.

In the Gulf South region, the Ochsner Thoracic Outlet Syndrome Center provides the level of comprehensive expertise required to diagnose and treat all forms of TOS. As the leading health system in the region and an academic medical center, the Ochsner team has experience across various disciplines, including vascular surgery, pain management, physical and occupational therapy, neurology, radiology, anesthesia and surgery. Orthopedic, sports medicine, neurosurgery and interventional cardiology specialists are also available as needed.

Ochsner is home to the only team in the region that offers comprehensive diagnosis and management for patients with all forms of TOS. At the Ochsner Thoracic Outlet Syndrome Center, patients receive unparalleled care and experience stellar clinical outcomes.

If you think you might have TOS and would like a second opinion, call 504-703-8346 for an evaluation.

Thoracic outlet syndrome is divided into 3 types depending on what structure is compressed:

Neurogenic Thoracic Outlet Syndrome (NTOS)

Neurogenic thoracic outlet syndrome is the most common type of TOS and comprises 95% of all patients diagnosed with TOS. Compression of the nerves can lead to a variety of symptoms including arm shoulder and/or neck pain, tingling, numbness and weakness. Only a fraction of patients with neurogenic TOS require surgery since the majority of patients improve with non-surgical treatment. The diagnosis of NTOS is challenging and may require many different evaluations and tests to rule out other conditions that can cause similar symptoms.

Venous Thoracic Outlet Syndrome (VTOS)

Venous thoracic outlet syndrome is the second most common type of TOS and comprises 4% of all patients diagnosed with thoracic outlet syndrome. Compression or blockage of the vein results in arm swelling, change in color and enlarged veins in the arm and chest. Most patients with venous thoracic outlet syndrome require surgery to improve arm swelling and prevent future blood clots.

Arterial Thoracic Outlet Syndrome (ATOS)

Arterial thoracic outlet syndrome is a very rare disorder comprising less than 1% of all patients diagnosed with TOS. Compression of the artery can cause damage which can lead to aneurysm or blockage of the artery causing pain in the arm or hand.

There are many different causes of thoracic outlet syndrome. Some people are born with different anatomy such as an abnormal first rib or an extra rib which makes them more likely to develop thoracic outlet syndrome. Other patients may be more likely to develop TOS due to repetitive motions in a sport or job, sports-related injuries or physical trauma.

Diagnosis of thoracic outlet syndrome is complex and varies depending on the symptoms and form of TOS that is suspected. A thorough history and physical examination is critical to initially suspect the diagnosis. To verify or rule out TOS, your team may recommend diagnostic imaging such as X-ray, CT, MRI or ultrasound. Other tests such as EMG/nerve conduction studies, angiograms and/or nerve blocks may also be necessary.

The treatment for thoracic outlet syndrome varies depending on the symptoms and form of TOS that is suspected. Treatment for neurogenic TOS often begins with physical therapy to relieve compression by strengthening chest/back muscles and restoring normal posture. Blood thinners may be necessary to prevent or treat blood clots in patients with venous or arterial TOS. Finally, your team may recommend surgery to release or remove the source of compression.