Click to enlarge. Patient Info

Essam El-Kady, chief of Vascular Surgery at the El Maadi Armed Forces Hospital in Cairo, Egypt operating with Dr. Brantigan. Click to enlarge.

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Thoracic Outlet Syndrome 

The thoracic outlet is a triangular shaped opening to the chest located at the base of the neck. Through this outlet, exit the main vein, artery, and nerves that supply the arm. In some individuals the outlet, becomes narrowed because of muscle spasm due to fibrous bands, scar tissue, or bony abnormalities. Compression of the vein, artery or nerves can occur when this happens.

Symptoms and Diagnosis

Symptoms of this syndrome is complex because symptoms may vary. Problems with the nerves can include numbness and/or pain in the hand, arm, or shoulder. Additionally, when nerves are compressed, it is not uncommon to feel neck and facial pain as well. If the vein is compressed, it causes swelling and color changes in the arm. If the artery is involved, an aneusym may form and small clots may be passed into the arm.


Once the diagnosis of thoracic outlet syndrome is made, two courses are available for treatment: physical therapy and/or surgery. In some cases an gentle stretching program can relieve nerve compression symptoms. This is done by giving patients a regime to follow using alternative therapies easing the neurologic symptoms above. Specialized therapists in the feild of TOS will work with our patients prior to surgery and follow their progress postoperatively. All of these treatments will be arranged prior to your visit.

If this therapy is not successful and pain or disability is interfering with daily tasks, surgery may be considered. If circulation to the arm is compromised or major nerve damage is found, surgery may be recommended without physical therapy. Prior to surgery, your doctor will have a thorough discussion of your symptoms, expected benefits and potential complications of TOS surgery. You will have all the information available to make an informed decision.


Last Updated: 12/10/2011