Thoracic outlet syndrome (TOS) is a disorder that may compress the blood vessels or nerves in the upper chest region — called the thoracic outlet. This area is behind and below the collarbone opposite the first rib.
At the UPMC Division of Vascular Surgery, we take a team approach to quickly and correctly diagnose your TOS and create a treatment plan that’s right for you.
To request an appointment, contact the UPMC Heart and Vascular Institute:
Thoracic outlet syndrome (TOS) is a group of disorders in which pressure on the arteries, veins, or nerves causes symptoms in the thoracic outlet or upper chest region.
TOS may cause symptoms in the:
The three types of TOS include:
TOS can occur on either side of the body, but most often affects the side of your dominant hand because of constant use.
Complications and symptoms vary depending on the type of TOS you have.
In arterial TOS, an artery in the thoracic outlet compresses, narrows, or dilates.
An extra rib (cervical) at the top of one’s rib cage or an abnormal first rib may cause this type of TOS.
Complications of arterial TOS can include:
A blood clot may break apart and smaller pieces — called emboli — can move down the arm.
This can block blood flow to the hand, causing:
It's vital to restore blood flow to the hand quickly.
In venous TOS, a vein in the thoracic outlet becomes compressed and damaged. The most common cause is repetitive, strenuous use of the shoulder and arm.
Complications of venous TOS can include:
In neurogenic TOS, the brachial plexus — the bundle of nerves in the thoracic outlet — compresses, usually because of:
Neurogenic TOS complications can include:
TOS happens to people of all ages and both genders.
Factors that can increase your risk of TOS include:
Doctors from UPMC's Division of Vascular Surgery are experts in treating all types of TOS.
Our TOS experts
Thoracic outlet syndrome (TOS) most often causes symptoms in the upper extremities, such as the:
Symptoms vary based on the type of TOS.
Symptoms of arterial TOS include:
Symptoms of venous TOS include:
Symptoms of neurogenic TOS include:
To confirm a diagnosis of TOS, your doctor at the UPMC Heart and Vascular Institute will begin by:
Your doctor also may order heart imaging and other diagnostic tests, including:
The UPMC Heart and Vascular Institute’s vascular surgeons offer a range of treatments for arterial, venous, and neurogenic thoracic outlet syndrome (TOS).
Based on the type of TOS you have, we will provide a course of treatment that meets your needs.
Your surgeon may operate to:
Your vascular surgeon may operate to:
For those who fail to respond to conservative therapies, doctors may suggest surgery.
Surgical options for neurogenic TOS may include:
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