Thoracic Outlet Syndrome (TOS) Sydney – Diagnosis & Treatment
Thoracic Outlet Syndrome (TOS) is a group of conditions caused by compression of the brachial plexus nerves or the subclavian blood vessels (artery and/or vein) as they pass through the thoracic outlet—the space between the collarbone and first rib.
Thoracic Outlet Syndrome may affect the nerves, arteries, veins, or a combination of these structures, resulting in pain, numbness, weakness, swelling or reduced blood flow affecting the neck, shoulder, arm and hand.
Types of Thoracic Outlet Syndrome
There are three main types of Thoracic Outlet Syndrome:
- Arterial Thoracic Outlet Syndrome (ATOS) – compression of the subclavian artery.
- Venous Thoracic Outlet Syndrome (VTOS) – compression of the subclavian vein.
- Neurogenic Thoracic Outlet Syndrome (NTOS) – compression of the brachial plexus nerves.
Symptoms
Symptoms vary depending on whether nerves or blood vessels are affected.
Neurogenic Thoracic Outlet Syndrome
- Neck, shoulder and arm pain
- Numbness or tingling in the hand and fingers
- Arm weakness or fatigue
- Heaviness during overhead arm activity
- Reduced grip strength
Venous Thoracic Outlet Syndrome
- Sudden arm swelling
- Bluish discolouration of the arm
- Arm heaviness and pain
- Subclavian vein thrombosis (Paget–Schroetter syndrome)
Arterial Thoracic Outlet Syndrome
- Cold or pale fingers
- Hand pain during activity
- Reduced blood flow to the hand
- Finger embolisation
- Subclavian artery aneurysm or arterial compression
Causes
The thoracic outlet is a naturally confined anatomical space. Certain anatomical variations or repetitive movements can increase pressure on nearby nerves and blood vessels.
Common causes include:
- Cervical ribs
- Abnormal or rudimentary first ribs
- Scalene muscle hypertrophy
- Variations in surrounding muscles or ligaments
- Previous trauma or injury
- Repetitive overhead activity or heavy lifting
Athletes and people whose work involves repetitive overhead arm movements may be at increased risk of developing Thoracic Outlet Syndrome.
Diagnosis
Accurate diagnosis requires careful clinical assessment by an experienced vascular surgeon because symptoms can overlap with cervical spine disorders, shoulder pathology and neurological conditions.
Assessment may include:
- Detailed vascular and neurological examination
- Dynamic duplex vascular ultrasound with provocative manoeuvre testing
- CT angiography or MR angiography
- Venography or arterial imaging
- Nerve conduction studies where appropriate
Treatment
Treatment depends on the type and severity of Thoracic Outlet Syndrome.
Non-Surgical Treatment
Many patients benefit from:
- Physiotherapy
- Postural correction
- Activity modification
- Pain management strategies
Surgical Treatment
For selected patients, thoracic outlet decompression surgery may be recommended. Depending on the underlying cause, surgery may include:
- First rib resection
- Scalenectomy
- Thoracic outlet decompression
- Subclavian vein decompression
- Arterial reconstruction
- Venous reconstruction where required
Thoracic Outlet Syndrome Specialist Sydney
Dr Igor Banzic provides specialist assessment and surgical management of arterial, venous and neurogenic Thoracic Outlet Syndrome. His practice has a dedicated vascular compression syndrome programme, with on-site dynamic duplex ultrasound including provocative manoeuvre testing available at Northern Sydney Vascular.
Patients are referred from across Sydney, regional New South Wales and interstate for comprehensive assessment, accurate diagnosis and surgical treatment of Thoracic Outlet Syndrome.
