Overview

Thoracic outlet syndrome is a group of disorders that occur when the nerves in the brachial plexus and the blood vessels of the subclavian artery and subclavian vein are compressed in the anatomic region known as the thoracic outlet (between the collarbone and the first rib). This includes the area from the neck to the underarm.

There are three types of thoracic outlet syndrome (TOS):

• Neurogenic thoracic outlet syndrome (nerve-related) is the most common form of TOS that results from abnormalities in the lower neck and upper chest compressing the brachial plexus. This plexus of nerves innervates the chest, shoulder and arm to control the function of movement (motor) and feeling (sensory) in the arms and hands.
• Venous thoracic outlet syndrome (vein-related) results when the major vein in the upper chest is damaged. Common symptoms include discoloration, swelling, and blood clots in the arm.
• Arterial thoracic outlet syndrome (artery-related) is a rare form of TOS that occurs when compression damages the blood vessel under the collarbone. Common symptoms are pain and arm that feels cool to the touch.

Innovative treatment for thoracic outlet syndrome

Many patients can be treated for TOS without surgery. Common treatments include ultrasound-guided injections in the neck and upper chest region, medications, and physical therapy. Often, a combination of these treatments provides optimal results. Making the correct TOS diagnosis is key to successful treatment, and your Mass General Brigham care team will customize a diagnostic program specifically for you using techniques such as CT scans, high-resolution MRI, vascular studies, and nerve-conduction studies.

Your doctor may recommend surgery to treat your TOS. This may include decompression surgery, vein repair, or rarely artery repair.

Surgery for TOS may also involve:

• Removal of the first thoracic rib
• Partial removal of the scalene muscles
• Removal of other tissues or scarring which may be causing compression of the thoracic outlet
• If present, removal of an additional rib located in the lower neck located in the spine, cervical rib
• Release of the pectoralis minor muscle
• Reconstruction of the subclavian vein or artery

The goal of surgery is to take pressure off the nerves and allow the body to use its own healing process in helping the nerve to recover. The vast majority of patients improve significantly after surgery.

Multidisciplinary and comprehensive thoracic outlet syndrome care

The Mass General Brigham TOS team will ensure you understand your healthcare choices and have the necessary information to make decisions affecting your health and well-being as an international patient. Our doctors work with specialist services across Mass General Brigham, including pain management, neurology, orthopedic surgery, vascular surgery, physical and occupational therapy, vascular and interventional radiology, and physical medicine and rehabilitation.

Thoracic outlet syndrome: Sydney's story

Sydney Gill, a proud Canadian, has been on a long and painful road to recovery from thoracic outlet syndrome (TOS). Before her experience with this condition, Sydney was active with an exceptional passion for horseback riding, and taking care of her chickens and competing in equestrian events in her hometown. Her life took a turn when she started experiencing pain in her right arm when she was 9. As she got older, the pain continued to grow and disrupt her life, leading Sydney and her parents to seek medical care.

After three brachial plexus surgeries and several rounds of treatments did not provide lasting relief, the Gill family discovered Dean Donahue, MD, of Massachusetts General Hospital, and made their way down to Boston to learn more about her treatment options.

Click below to learn more about her story.

Your Mass General Brigham thoracic outlet syndrome care team

Meet Mass General Brigham's multidisciplinary team of specialist clinicians.