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Thoracic outlet syndrome (TOS)
COMPRESSION OF THE NEUROVASCULAR STRUCTURES AS THEY EXIT THROUGH THE THORACIC OUTLET
Our peripheral nerve surgeons are leading experts at treating thoracic outlet syndrome
About TOS
Thoracic outlet syndrome (TOS) is where compressed nerves and blood vessels between your collarbone and first rib cause neck and upper limb pain. It also causes neurological problems such as numbness in the arm and hand, and reduced function.
TOS may result from trauma, repetitive arm movements, tumours, or anatomical variations such as a cervical rib. It can also occur during pregnancy.
Need to know
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.
Patient stories
Yvette's story: From back pain to hip replacement surgery
Yvette (54) a journalist from Kent, started experiencing pain in her hip seven years ago in 2015. An ex-national gymnast who had been incredibly active and flexible her whole life, Yvette felt concerned about the growing discomfort impacting her quality of life, and so sought help from her GP.
A new hip and straight back into the spin of things
David’s gym video shows him repeatedly pushing up to 100kg on a single leg press – not particularly unusual for this keen cyclist, former competitive squash player and all-round fitness enthusiast. What is unusual is that 52-year-old David had hip surgery just 12 weeks earlier.
Michael's MAKO hip surgery to treat his arthritis
73 year-old Michael, an avid walker and charity worker, was diagnosed with arthritis in January 2021. After facing long waiting times and increasing pain that was becoming more frequent, he started to look elsewhere for treatment.
This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.