Thoracic Outlet Syndrome (TOS)

What is TOS?
The Thoracic Outlet represents a specific anatomic region between the collar bone, the first rib and muscles. Nerves and vessels pass through this narrow area and can get squashed there. Thoracic Outlet Syndrome develops in this case. The patient presents with various different symptoms including hand or arm swelling, skin color changes, pins and needles in the forearm or hand, loss of sensation or even loss of strength in their hand on the affected side.

How can be TOS diagnosed?
Clinical assessment by vascular surgeon is good start. Further investigation is required in a majority of cases and includes, ultrasound scan, CT scan and in some cases also angiogram (dye test). Neurological assessment might be helpful too.

How can be TOS treated?
Initial treatment is almost always non-operative. That means the patient needs to be examined by experienced physiotherapist first and undergo a trial of tailor-made range of body exercises (physiotherapy). If symptoms do not improve over time, surgical treatment is discussed with the patient. Based on underlying pathology found on CT scan/angiogram a decompressing surgical procedure is planned and explained to the patient in detail including all possible alternatives. Typically the first rib is cut out and nerves or vessels are relieved from being trapped in between muscles, tendons, bands and bones. The operation takes about one or two hours and patient usually stays in hospital only for one or two days.