Thoracic Outlet Syndrome

Understanding the Types of Thoracic Outlet Syndrome

Thoracic Outlet Syndrome is classified into three main types, depending on which structures are being compressed:

Neurogenic Thoracic Outlet Syndrome (nTOS) is the most common form, accounting for approximately 90% of cases. It occurs when the nerves in the brachial plexus are compressed, leading to symptoms such as progressive pain, tingling, numbness, and muscle weakness in the affected arm. Symptoms are often triggered or worsened by repetitive activities, making this form of TOS particularly common in athletes and individuals with physically demanding jobs.

Venous Thoracic Outlet Syndrome (vTOS) affects approximately 10% of patients and is also known as Paget-Schroetter disease. It develops when the subclavian vein is compressed, often due to repetitive arm motion or structural abnormalities. This condition is frequently seen in athletes such as baseball pitchers, swimmers, and volleyball players but can also affect non-athletes.

Many patients first seek treatment after developing a blood clot (deep vein thrombosis) in the compressed vein, leading to swelling, discoloration, and pain in the affected arm.

Arterial Thoracic Outlet Syndrome (aTOS) is the rarest form of TOS, occurring in fewer than 1% of cases. This type of TOS results from compression of the subclavian artery, restricting blood flow to the arm and hand. Patients often experience coldness, pain, weakness, or discoloration in the fingers, particularly during exertion. In some cases, the compression may lead to the formation of an aneurysm, requiring specialized vascular treatment.

Recognizing the Symptoms of Thoracic Outlet Syndrome

The symptoms of TOS vary depending on whether the nerves, veins, or arteries are compressed, but common signs include:

Neurogenic TOS Symptoms

• Numbness, tingling, or pain in the neck, shoulder, arm, or hand
• Weakness in the affected arm, especially with movement
• Pain that worsens with repetitive activities (e.g., lifting, typing, sports)

Venous TOS Symptoms

• Swelling and heaviness in the affected arm
• Discoloration (bluish tint) or prominent veins
• Sudden development of a blood clot in the arm

Arterial TOS Symptoms

• Hand and arm pain that worsens with exertion
• Cold or pale fingers due to reduced circulation
• Aneurysm formation in the compressed artery

Without treatment, severe TOS can lead to permanent nerve damage or circulation loss, making early diagnosis essential.

Diagnosing Thoracic Outlet Syndrome

Because TOS symptoms often mimic other conditions, proper evaluation is critical. Our Los Angeles and Santa Monica vascular specialists use a combination of clinical assessments and imaging studies to confirm the diagnosis.

Effective Treatment Options for Thoracic Outlet Syndrome

The treatment approach for TOS depends on its severity and type. Our vascular specialists in Los Angeles and Santa Monica provide a range of non-surgical, minimally invasive, and surgical treatments to relieve compression and restore function.

Neurogenic TOS

For neurogenic TOS, conservative management is the first step. Many patients benefit from physical therapy, posture correction, and pain management strategies. In cases where symptoms persist or worsen, surgical first rib resection may be recommended to relieve nerve compression.

Venous TOS

Venous TOS requires early intervention, particularly if a blood clot has formed. Treatment typically begins with clot-dissolving medications (thrombolysis) and anticoagulation therapy. Once the clot is addressed, a first rib resection and venoplasty procedure may be performed to prevent future compression and restore normal venous function.

Arterial TOS

For arterial TOS, treatment often involves first rib resection to eliminate compression. If an aneurysm is present, it may require surgical repair or bypass to restore blood flow and prevent complications.

At Vascular Surgery Associates, we specialize in the transaxillary approach for first rib resection, a technique that allows the rib to be removed through a small incision in the armpit. This method results in minimal scarring, improved cosmetic outcomes, and complete rib removal. Most patients stay in the hospital for 2-3 days after surgery for monitoring and pain management before being discharged home.