Thoracic outlet syndrome (TOS)

Trauma such as a car accident, repetitive movement such as weight-lifting and a particular anatomy of the neck can cause TOS. However, a main cause is a cervical rib. This is a rare condition where an extra rib grows from the neck. This presses down on the nerves and blood vessels causing pain.

Your consultant will discuss your symptoms with you to help make a diagnosis. They will ask questions about your medical history and the types of pain you've been having. In TOS, it's often easier to rule out other neurological conditions first. They may order:

• an x-ray of your chest to look for a cervical rib
• an MRI scan of the brachial plexus
• nerve conduction studies to identify TOS and to rule out carpal tunnel or neck irritation (cervical spondylosis) might be of use.

Pain relief and physiotherapy can be an effective cure for TOS. However, if your symptoms do not get better, your consultant may advise surgery.

Thoracic decompression surgery treats TOS. Here, your surgeon makes an incision in your neck, parting the muscles and removing the compression of the brachial plexus (the five main nerves that supply the whole of the upper limb). If a cervical rib is compressing the nerves, it will also be removed.