Conditions We Treat
Thoracic Outlet Syndrome (TOS)
What Is It?
Thoracic outlet syndrome (TOS) is a group of disorders caused by compression of nerves, arteries, or veins in the thoracic outlet — the space between the neck and shoulder. Compression may involve the brachial plexus, subclavian artery, or subclavian vein.
Symptoms
- Numbness, tingling, or weakness in the arm or hand
- Pain or fatigue in the shoulder, neck, or arm, especially overhead
- Swelling, discoloration, or coldness in the arm (vascular TOS)
- Symptoms worsen with prolonged posture or activity
Diagnosis
- Clinical history and physical tests: Adson’s, Roos, or Wright’s test
- X-rays to evaluate cervical ribs or abnormal anatomy
- MRI or CT angiography for vascular evaluation
- EMG/NCS to assess nerve involvement
Treatment
Conservative Options:
- Posture correction and activity modification
- Physical therapy focused on stretching scalene/pectoral muscles and strengthening
- NSAIDs or muscle relaxants
Interventional Options:
- Botox injection to reduce muscle compression (select cases)
Surgical Options:
- Surgical decompression for severe or vascular cases
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