thoracic outlet syndrome


Summary: A neurovascular syndrome associated with compression of the BRACHIAL PLEXUS; SUBCLAVIAN ARTERY; and SUBCLAVIAN VEIN at the superior thoracic outlet. This may result from a variety of anomalies such as a CERVICAL RIB, anomalous fascial bands, and abnormalities of the origin or insertion of the anterior or medial scalene muscles. Clinical features may include pain in the shoulder and neck region which radiates into the arm, PARESIS or PARALYSIS of brachial plexus innervated muscles, PARESTHESIA, loss of sensation, reduction of arterial pulses in the affected extremity, ISCHEMIA, and EDEMA. (Adams et al., Principles of Neurology, 6th ed, pp214-5).

Top Publications

  1. Mackinnon S, Novak C. Thoracic outlet syndrome. Curr Probl Surg. 2002;39:1070-145 pubmed
  2. Hug U, Jung F, Guggenheim M, Wedler V, Burg D, Kunzi W. ["True neurologic thoracic outlet syndrome" -- anatomical features and electrophysiological long-term follow-up of lateral thenar atrophy]. Handchir Mikrochir Plast Chir. 2006;38:42-5 pubmed
    ..muscles of the hand are considered to be a typical symptom of the "true neurologic" form of thoracic outlet syndrome (TOS)...
  3. Schneider D, Dimuzio P, Martin N, Gordon R, Wilson M, LaBerge J, et al. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg. 2004;40:599-603 pubmed
    Residual subclavian vein stenosis after thoracic outlet decompression in patients with venous thoracic outlet syndrome is often treated with postoperative percutaneous angioplasty (PTA)...
  4. Degeorges R, Reynaud C, Becquemin J. Thoracic outlet syndrome surgery: long-term functional results. Ann Vasc Surg. 2004;18:558-65 pubmed
    The treatment of thoracic outlet syndrome (TOS) is controversial and long-term results are poorly documented...
  5. Sanders R, Hammond S, Rao N. Thoracic outlet syndrome: a review. Neurologist. 2008;14:365-73 pubmed publisher
    Arterial and venous thoracic outlet syndrome (TOS) were recognized in the late 1800s and neurogenic TOS in the early 1900s. Diagnosis and treatment of the 2 vascular forms of TOS are generally accepted in all medical circles...
  6. Huang J, Zager E. Thoracic outlet syndrome. Neurosurgery. 2004;55:897-902; discussion 902-3 pubmed
    b>Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine...
  7. Forcada P, Rodriguez Niedenführ M, Llusa M, Carrera A. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome. Clin Anat. 2001;14:55-7 pubmed
    ..The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.
  8. Tilki H, Stålberg E, Incesu L, Basoglu A. Bilateral neurogenic thoracic outlet syndrome. Muscle Nerve. 2004;29:147-50 pubmed
    We report a case of bilateral neurogenic thoracic outlet syndrome (TOS). Electrophysiological examination suggested the presence of bilateral lower brachial plexus neuropathy. Radiography showed rudimentary bilateral cervical ribs...
  9. Hood D, Kuehne J, Yellin A, Weaver F. Vascular complications of thoracic outlet syndrome. Am Surg. 1997;63:913-7 pubmed
    Vascular complications of thoracic outlet syndrome are uncommon but may result in significant long-term disability. This report documents a retrospective review of 17 such patients...

More Information


  1. Crosby C, Wehbé M. Conservative treatment for thoracic outlet syndrome. Hand Clin. 2004;20:43-9, vi pubmed
    Conservative treatment of thoracic outlet syndrome consists initially of pain control and medicinal and physical measures. Therapy then addresses tight muscles, with strengthening of weakened neck and shoulder girdle muscles...
  2. Mosley J. Arterial problems in athletes. Br J Surg. 2003;90:1461-9 pubmed
    ..Athletes may experience arterial problems that may jeopardize their careers. If recognized promptly, operative intervention may permit a return to the highest level of sporting achievement. ..
  3. Matsuyama T, Okuchi K, Goda K. Upper plexus thoracic outlet syndrome--case report. Neurol Med Chir (Tokyo). 2002;42:237-41 pubmed
    ..Postoperatively, all symptoms completely resolved and the patient was discharged 5 days after surgery. Thoracic outlet syndrome (TOS) manifests as symptoms of lower cervical nerve involvements with hypesthesia and paresthesia...
  4. Sheth R, Campbell J. Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations. J Neurosurg Spine. 2005;3:355-63 pubmed
    Various surgical approaches have been proposed for the treatment of thoracic outlet syndrome (TOS)...
  5. Davidovic L, Kostic D, Jakovljevic N, Kuzmanovic I, Simic T. Vascular thoracic outlet syndrome. World J Surg. 2003;27:545-50 pubmed
    The surgical treatment of 30 cases of vascular thoracic outlet syndrome (TOS) in 25 patients is presented. Patients included 17 women and 8 men with average age of 26.1 years...
  6. Wehbé M, Whitaker M. Epineurectomy for thoracic outlet syndrome. Hand Clin. 2004;20:83-6 pubmed
    ..The authors encourage patients to attend therapy for approximately 3 months after surgery, and to follow a home program of rehabilitation to maximize their gains and decrease the chance of recurrence...
  7. Nichols A. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep. 2009;8:240-9 pubmed publisher
    b>Thoracic outlet syndrome (TOS) results from compression of the neurovascular structures that pass through the thoracic outlet. TOS may be classified as neurogenic TOS (NTOS), venous TOS (VTOS), or arterial TOS (ATOS)...
  8. Atasoy E. Thoracic outlet syndrome: anatomy. Hand Clin. 2004;20:7-14, v pubmed
    ..Compression can occur in any of these three spaces because of structural anomalies or trauma...
  9. Brantigan C, Roos D. Diagnosing thoracic outlet syndrome. Hand Clin. 2004;20:27-36 pubmed
    Diagnosing and treating thoracic outlet syndrome can be challenging and frustrating. It must be emphasized that the diagnosis of TOS is a clinical one based on a detailed history and physical examination...
  10. Braun R, Sahadevan D, Feinstein J. Confirmatory needle placement technique for scalene muscle block in the diagnosis of thoracic outlet syndrome. Tech Hand Up Extrem Surg. 2006;10:173-6 pubmed
    ..of primary sources of pain and weakness in the upper limb when the differential diagnosis includes thoracic outlet syndrome. This presentation offers a simple clinical method to assess needle placement in the scalene muscle ..
  11. Aydog S, Ozcakar L, Demiryurek D, Bayramoglu A, Yorubulut M. An intervening thoracic outlet syndrome in a gymnast with levator claviculae muscle. Clin J Sport Med. 2007;17:323-5 pubmed
  12. Atasoy E. Recurrent thoracic outlet syndrome. Hand Clin. 2004;20:99-105 pubmed
  13. Athanassiadi K, Kalavrouziotis G, Karydakis K, Bellenis I. Treatment of thoracic outlet syndrome: long-term results. World J Surg. 2001;25:553-7 pubmed
    b>Thoracic outlet syndrome (TOS) refers to a complex of symptoms in the upper extremity caused by compression of the neural and vascular structures at some point between the interscalene triangle and the inferior border of the axilla...
  14. Finlayson H, O Connor R, Brasher P, Travlos A. Botulinum toxin injection for management of thoracic outlet syndrome: a double-blind, randomized, controlled trial. Pain. 2011;152:2023-8 pubmed publisher
    ..the effect of botulinum toxin type A (BTX-A) injections to the scalene muscles on pain in subjects with thoracic outlet syndrome (TOS) in this double-blind, randomized, parallel group trial with follow-up at 6 weeks, 3 months, and 6 ..
  15. Sabapathy S, Venkatramani H, Bhardwaj P. Pseudarthrosis of cervical rib: an unusual cause of thoracic outlet syndrome. J Hand Surg Am. 2010;35:2018-21 pubmed publisher
    b>Thoracic outlet syndrome is uncommon in adolescence. Cervical rib fracture is an extremely rare cause of thoracic outlet syndrome in this age group...
  16. Ozcakar L, Inanici F, Kaymak B, Abali G, Cetin A, Hascelik Z. Quantification of the weakness and fatigue in thoracic outlet syndrome with isokinetic measurements. Br J Sports Med. 2005;39:178-81 pubmed
    Patients with thoracic outlet syndrome (TOS) complain of many subjective symptoms that are difficult to measure and quantify...
  17. Danielson K, Odderson I. Botulinum toxin type A improves blood flow in vascular thoracic outlet syndrome. Am J Phys Med Rehabil. 2008;87:956-9 pubmed publisher
    A 28-yr-old man, diagnosed with vascular thoracic outlet syndrome, had his right anterior scalene muscle injected with botulinum toxin type A under ultrasound guidance...
  18. Machanic B, Sanders R. Medial antebrachial cutaneous nerve measurements to diagnose neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2008;22:248-54 pubmed publisher
    A reliable objective test is still needed to confirm the diagnosis of neurogenic thoracic outlet syndrome (NTOS)...
  19. Ide J, Kataoka Y, Yamaga M, Kitamura T, Takagi K. Compression and stretching of the brachial plexus in thoracic outlet syndrome: correlation between neuroradiographic findings and symptoms and signs produced by provocation manoeuvres. J Hand Surg Br. 2003;28:218-23 pubmed
    In order to investigate the mechanism of nerve irritation in thoracic outlet syndrome (TOS), we studied 150 patients who presented with symptoms of neurologic TOS between 1985 and 1999...
  20. Piyawinijwong S, Sirisathira N. Supernumerary subclavius muscle in Thais: predisposing cause of thoracic outlet syndrome. J Med Assoc Thai. 2010;93:1065-9 pubmed
    ..To demonstrate and classify the variation of the subclavius muscle according to its insertion in the Thais...
  21. Chon S, Lee C, Oh Y. Calcifying fibrous pseudotumor causing thoracic outlet syndrome. Eur J Cardiothorac Surg. 2005;27:353-5 pubmed
    ..The patient is a 34-year-old woman presenting symptoms of numbness of her right upper extremity caused by a CFP in her thoracic outlet and we discuss its clinical significance with a review of the literature...
  22. Almeida D, Meyer R, Oh S. True neurogenic thoracic outlet syndrome in a competitive swimmer: a case report of this rare association. Arq Neuropsiquiatr. 2007;65:1245-8 pubmed
    True neurogenic thoracic outlet syndrome (TOS) is an uncommon disorder despite of be a frequent reason for referral to the EMG laboratories...
  23. Sanders R, Hammond S, Rao N. Diagnosis of thoracic outlet syndrome. J Vasc Surg. 2007;46:601-4 pubmed
    b>Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS...
  24. Kitsis C, Marino A, Krikler S, Birch R. Late complications following clavicular fractures and their operative management. Injury. 2003;34:69-74 pubmed
    ..This included the following: painful non-union (nine patients), neurogenic thoracic outlet syndrome (TOS), hypertrophic non-union three patients, hypertrophic malunion five patients, bony spike two ..
  25. Ambrad Chalela E, Thomas G, Johansen K. Recurrent neurogenic thoracic outlet syndrome. Am J Surg. 2004;187:505-10 pubmed
    Although 90% of patients with neurogenic thoracic outlet syndrome (NTOS) experience "excellent" or "good" results after thoracic outlet decompression, recurrent symptoms may develop in certain patients.
  26. Gillard J, Perez Cousin M, Hachulla E, Remy J, Hurtevent J, Vinckier L, et al. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine. 2001;68:416-24 pubmed
    To evaluate the diagnostic usefulness of provocative tests, Doppler ultrasonography, electrophysiological investigations, and helical computed tomography (CT) angiography in thoracic outlet syndrome (TOS).
  27. Connolly J, Ganjianpour M. Thoracic outlet syndrome treated by double osteotomy of a clavicular malunion: a case report. J Bone Joint Surg Am. 2002;84-A:437-40 pubmed
  28. Sanders R, Hammond S. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg. 2002;36:51-6 pubmed
    Cervical and anomalous first ribs are rare conditions, occurring in less than 1% of the population. This manuscript reviews our management of neurogenic thoracic outlet syndrome (TOS) associated with these congenital anomalies.
  29. de León R, Chang D, Hassoun H, Black J, Roseborough G, Perler B, et al. Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery. 2009;145:500-7 pubmed publisher
    We sought to determine the outcomes in patients presenting with venous thoracic outlet syndrome.
  30. Remy Jardin M, Remy J, Masson P, Bonnel F, Debatselier P, Vinckier L, et al. CT angiography of thoracic outlet syndrome: evaluation of imaging protocols for the detection of arterial stenosis. J Comput Assist Tomogr. 2000;24:349-61 pubmed
    ..The purpose of this work was to evaluate the results of cross-sectional imaging and multiplanar and 3D reconstructions for the detection of thoracic outlet arterial stenosis on CT angiograms...
  31. Sanders R, Rao N. The forgotten pectoralis minor syndrome: 100 operations for pectoralis minor syndrome alone or accompanied by neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2010;24:701-8 pubmed publisher
    Since 2005 when we became aware of pectoralis minor syndrome (PMS), more than 75% of patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) also have neurogenic PMS (NPMS), and about 30% have only NPMS, without NTOS.
  32. Brantigan C, Roos D. Etiology of neurogenic thoracic outlet syndrome. Hand Clin. 2004;20:17-22 pubmed
    ..There are some promising technologies that offer hope of early anatomic diagnosis. Sophisticated imaging of the brachial plexus as advocated by Collins offers hope. High resolution multidetector CT scanning seems even more promising...
  33. Yeow K, Hsieh H. Thoracic outlet syndrome caused by first rib hemangioma. J Vasc Surg. 2001;33:1118-21 pubmed
    We report a case of first rib hemangioma that caused thoracic outlet syndrome. A 50-year-ole woman who was admitted to our hospital with a clinical diagnosis of thoracic outlet syndrome presented with fullness and easy fatigue of her ..
  34. Inoue S. Thoracic outlet syndrome and anaesthetic problems. Acta Anaesthesiol Scand. 2004;48:136 pubmed
  35. Ozoa G, Alves D, Fish D. Thoracic outlet syndrome. Phys Med Rehabil Clin N Am. 2011;22:473-83, viii-ix pubmed publisher
    Of the many clinical entities involving the neck region, one of the most intriguing is thoracic outlet syndrome (TOS). TOS is an array of disorders that involves injury to the neurovascular structures in the cervicobrachial region...
  36. Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. Radiographics. 2006;26:1735-50 pubmed
    ..induced compression of the neural, arterial, or venous structures crossing these compartments leads to thoracic outlet syndrome (TOS)...
  37. Cruz Martinez A, Arpa J. Electrophysiological assessment in neurogenic thoracic outlet syndrome. Electromyogr Clin Neurophysiol. 2001;41:253-6 pubmed
    To evaluate the value of different electrophysiological techniques in the diagnosis of neurogenic thoracic outlet syndrome (TOS).
  38. Atasoy E. Combined surgical treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical scalenectomy. Hand Clin. 2004;20:71-82, vii pubmed
    ..first rib resection and transcervical scalenectomy are common procedures used for treatment of thoracic outlet syndrome (TOS)...
  39. Sergeant G, Gheysens O, Seynaeve P, Van Cauwelaert J, Ceuppens H. Neurovascular compression by a subpectoral lipoma. A case report of a rare cause of thoracic outlet syndrome. Acta Chir Belg. 2003;103:528-31 pubmed
    ..Lipomas are benign soft tissue tumours, progressively expanding in volume. Beside frequent aesthetic consequences, lipomas can also exert pressure on surrounding tissues and structures...
  40. Tolson T. "EMG" for thoracic outlet syndrome. Hand Clin. 2004;20:37-42, vi pubmed
    ..Electrodiagnostic testing is reliable for the diagnosis of TOS. It helps localize and quantify a lesion in the brachial plexus. It is also important to rule out other segmental or systemic neuropathies...
  41. Cagli K, Ozcakar L, Beyazit M, Sirmali M. Thoracic outlet syndrome in an adolescent with bilateral bifid ribs. Clin Anat. 2006;19:558-60 pubmed
    ..She was diagnosed to have right thoracic outlet syndrome due to bifid ribs--caused by the bony fusion of the variant cervical rib...
  42. Vanti C, Natalini L, Romeo A, Tosarelli D, Pillastrini P. Conservative treatment of thoracic outlet syndrome. A review of the literature. Eura Medicophys. 2007;43:55-70 pubmed
    b>Thoracic outlet syndrome (TOS) is a debated topic. While there are many clinical studies concerning the efficacy of surgical treatment, there are few regarding conservative treatment...
  43. Gezer S, Altinok T, Agackiran Y, Tastepe I. Hydatid disease of the first rib causing thoracic outlet syndrome. Med Princ Pract. 2007;16:68-70 pubmed
    To present a case of hydatid disease of the first rib as a rare cause of thoracic outlet syndrome.
  44. Bahm J. Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS). Acta Neurochir Suppl. 2007;100:137-9 pubmed
    b>Thoracic outlet syndrome is a complex and multifactorial disease. There are multiple diagnostic steps and possible treatment options. The scientific literature not always contributes to a "unifying vision".
  45. Wehbé M, Schlegel J. Nerve gliding exercises for thoracic outlet syndrome. Hand Clin. 2004;20:51-5, vi pubmed
    Nerve gliding exercises (NGE) are an important part of the treatment of thoracic outlet syndrome (TOS), whether conservative or surgical. They also can be useful for other peripheral nerve problems.
  46. Plewa M, Delinger M. The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects. Acad Emerg Med. 1998;5:337-42 pubmed
    To estimate the incidence of false-positive findings of thoracic outlet syndrome (TOS) shoulder maneuvers, Adson's test (AT), costoclavicular maneuver (CCM), elevated arm stress test (EAST), and supraclavicular pressure (SCP) in healthy ..
  47. Christo P, Christo D, Carinci A, Freischlag J. Single CT-guided chemodenervation of the anterior scalene muscle with botulinum toxin for neurogenic thoracic outlet syndrome. Pain Med. 2010;11:504-11 pubmed publisher
    To examine pain relief in patients with neurogenic thoracic outlet syndrome (NTOS) after a single, low dose injection of botulinum toxin A (Botox) into the anterior scalene muscle (ASM) under computed tomographic (CT) guidance.
  48. Torriani M, Gupta R, Donahue D. Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach. Skeletal Radiol. 2010;39:973-80 pubmed publisher
    The purpose of this study was to describe the technique, complications, and rate of symptom relief after ultrasound-guided botulinum toxin injection in subjects with suspected neurogenic thoracic outlet syndrome (NTOS).
  49. Maru S, Dosluoglu H, Dryjski M, Cherr G, Curl G, Harris L. Thoracic outlet syndrome in children and young adults. Eur J Vasc Endovasc Surg. 2009;38:560-4 pubmed publisher
    b>Thoracic outlet syndrome has been well described in the population between 25 and 40 years of age, and is less frequently reported in those in the first two decades of life...
  50. Nord K, Kapoor P, Fisher J, Thomas G, Sundaram A, Scott K, et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol. 2008;48:67-74 pubmed
    In this study, we aim to determine the false-positive rate & specificity in normal subjects and carpal tunnel syndrome (CTS) patients of five provocative maneuvers used to diagnose thoracic outlet syndrome (TOS).
  51. Cordobes Gual J, Lozano Vilardell P, Torreguitart Mirada N, Lara Hernandez R, Riera Vazquez R, Julia Montoya J. Prospective study of the functional recovery after surgery for thoracic outlet syndrome. Eur J Vasc Endovasc Surg. 2008;35:79-83 pubmed
    The aim of this study is to evaluate the functional recovery after Thoracic Outlet Syndrome (TOS) surgery, by the application of Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
  52. Jordan S, Ahn S, Gelabert H. Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: comparison with fluoroscopy and electromyography guidance. Pain Physician. 2007;10:541-6 pubmed
  53. Kim T, Uhm W, Song S, Jun J. Unilateral weak radial pulse in a patient with systemic sclerosis: Takayasu's arteritis or thoracic outlet syndrome?. Rheumatol Int. 2007;27:789-90 pubmed
  54. Konstantinou D, Chroni E, Constantoyiannis C, Dougenis D. Klippel-Feil syndrome presenting with bilateral thoracic outlet syndrome. Spine (Phila Pa 1976). 2004;29:E189-92 pubmed
    This report aims, in the light of the recent literature, to describe the clinical features of bilateral thoracic outlet syndrome in a case of Klippel-Feil syndrome, the results of electrophysiologic evaluation, and the outcome after ..
  55. Schneider D, Curry T, Eichler C, Messina L, Gordon R, Kerlan R. Percutaneous mechanical thrombectomy for the management of venous thoracic outlet syndrome. J Endovasc Ther. 2003;10:336-40 pubmed
    To describe the successful use of percutaneous mechanical thrombectomy as an adjunct to thrombolysis for acute subclavian vein thrombosis due to venous thoracic outlet syndrome.
  56. Nannapaneni R, Marks S. Neurogenic thoracic outlet syndrome. Br J Neurosurg. 2003;17:144-8 pubmed
    Current concepts for the diagnosis of neurogenic thoracic outlet syndrome are presented together with the surgical experience and results in series of 51 patients caused by a cervical rib...
  57. Balci A, Balci T, Cakir O, Eren S, Eren M. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg. 2003;75:1091-6; discussion 1096 pubmed
    Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience.
  58. Rousseff R, Tzvetanov P, Valkov I. Utility (or futility?) of electrodiagnosis in thoracic outlet syndrome. Electromyogr Clin Neurophysiol. 2005;45:131-3 pubmed
    The objective diagnosis of thoracic outlet syndrome (TOS) remains a challenge...
  59. Okamoto H, Kawai K, Hattori S, Ogawa T, Kubota Y, Moriya H, et al. Thoracic outlet syndrome combined with carpal tunnel syndrome and Guyon canal syndrome in a child. J Orthop Sci. 2005;10:634-40 pubmed