Thoracic Outlet Syndrome Treatment Overview

When to see a healthcare provider

Always see a healthcare provider if you have signs of thoracic outlet syndrome (TOS). Depending on the type of TOS you have, symptoms may include pain in the upper arm, swollen and heavy arm that may be darker in color, or pain or numbness in the fingers and hand.

If untreated, TOS can lead to complications like blood clots, permanent pain and arm swelling, open sores on the fingers, gangrene (tissue death), and permanent nerve damage. There are three types of TOS and your treatment will vary depending on what type you have.

Getting diagnosed

TOS can be challenging to diagnose because it shares symptoms with many other conditions. It is diagnosed based on symptoms, a physical exam, and tests including:

• Ultrasound to look for signs of vascular thoracic outlet syndrome or other vascular problems.
• CT scan or MRI to determine the location and cause of blood vessel compression.
• Chest X-ray to rule out other conditions.
• Electromyography to check for nerve damage in the muscles.
• Arteriography and venography, which can reveal a compressed vein or artery.
• Brachial plexus block, which can help diagnose neurogenic TOS.

What to expect from your doctor visit

Neurogenic TOS

• Physical therapy is usually the first treatment your provider will recommend. The therapist teaches you exercises that can help reduce pressure on the blood vessels and nerves in the thoracic outlet.
• If physical therapy doesn’t help symptoms, Botox injections may be suggested to relieve pain.
• If you have muscle tension and difficulty moving, your provider may prescribe muscle relaxants.
• If these treatments don’t help, you may need surgery.

Venous TOS

• Venous TOS usually is treated with surgery to remove a rib or certain muscles.
• You may need a procedure called thrombolysis to remove a clot from the vein. Thrombolysis is typically done before surgery.
• Blood thinners may be prescribed to thin or prevent clots.

Arterial TOS

• Surgery is usually necessary to treat arterial TOS. A rib or muscles in the neck may be removed.
• If you have an aneurysm in the artery or a blood clot, the artery may be reconstructed or replaced.
• Blood thinners may be prescribed to treat clots.

Prescription thoracic outlet syndrome medications

• Muscle relaxants: methocarbamol (Robaxin), cyclobenzaprine (Flexeril)
• Blood thinners: warfarin (Coumadin), heparin, rivaroxaban (Xarelto), apixaban (Eliquis), fondaparinux (Arixtra)

Types of thoracic outlet syndrome providers

• A primary care provider can evaluate symptoms of TOS.
• A physical therapist can show you stretching and strengthening exercises to help with symptoms.
• If TOS is suspected, you will likely be referred to a vascular medicine specialist, who specializes in treating arteries and veins.
• You may be referred to a neurologist, who specializes in treating conditions of the nervous system, to rule out neurological conditions that cause TOS-like symptoms.
• If surgery is needed, you’ll be referred to a thoracic (chest) surgeon or vascular (blood vessel) surgeon.

Treating thoracic outlet syndrome at home

Always see a healthcare provider if you have thoracic outlet syndrome (TOS).

While the condition should be treated by a healthcare provider, those with one type of TOS, called neurogenic TOS, can take OTC pain relievers like acetaminophen (Tylenol) or ibuprofen (Motrin). There are a few lifestyle changes and home remedies that are recommended for all types of TOS:

• Do daily stretches of the chest, neck, and shoulders.
• Maintain good posture.
• Do exercises that strengthen the shoulder muscles.
• Do not carry a heavy bag on your shoulder.
• Limit repetitive movements and avoid lifting heavy objects.
• Lose weight, if necessary.
• Gently massage the shoulders.
• Place a heating pad on the affected area.
• Use relaxation techniques like deep breathing and meditation.