Thoracic Diseases Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a diagnosis steeped in controversy. The term is used to describe symptoms arising from compression of either the subclavian artery that supplies blood to the head and arms, and passes beneath the clavicle (arterial TOS), the subclavian vein (venous TOS), or brachial plexus, a group of spinal nerves emerging from the neck and leading into the arms (neurogenic TOS). Symptoms of TOS include pain in the neck and shoulder areas and numbness in the arm and hand.

Arterial and venous TOS are well-recognized entities, however they account for less than 5% of patients with the condition. By far, the majority of patients with this diagnosis have neurogenic TOS. The diagnosis itself is controversial. Many believe that neurogenic TOS does not exist because there are no universally-accepted objective tests available to diagnose it. Those who do believe the diagnosis exists argue that there is a large collective experience from many countries with patients who exhibit symptoms characteristic of neurogenic TOS and who improve after surgery directed at decompression of the lower brachial plexus.

The Division of Thoracic surgery believes that neurogenic TOS does exist, and that some patients with TOS require surgery for relief of their symptoms. All patients with neurogenic TOS are first prescribed physical therapy to increase motion in the neck and shoulders, strengthen muscles, and improve posture. Only those whose severe symptoms persist after physical therapy are considered eligible for surgery.

We favor a video-assisted, minimally-invasive approach that affords complete visualization and enables us to reduce the size of the incision. Our long term success rate with this approach is greater than 90%. The most common postoperative complaint is numbness on the inner part of the arm, which tends to subside over time.