Thoracic Outlet Syndrome
Thoracic outlet syndrome is a group of conditions in which nerves or blood vessels are compressed between the collarbone and first rib. It causes arm pain, numbness, weakness, or circulation changes — especially with overhead activity.
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Treatment depends on whether nerves, blood vessels, or both are involved. Provocative activities should be avoided.
Non-surgical treatment:
• NSAIDs or muscle relaxants to reduce inflammation and symptoms
• Injections into the scalene muscles (steroids, anesthetics, or Botox)
• Physical therapy to strengthen muscles and improve posture
• If a vascular clot is present, catheter-directed clot dissolution followed by oral anticoagulation may be required
Surgical treatment:
Surgery is considered when symptoms are severe or don't respond to conservative care. The specific approach is tailored to each patient:
• Supraclavicular approach: an incision above the collarbone to remove an extra rib or tight muscle and widen the outlet
• Infraclavicular approach: an incision below the collarbone to address the compression
• Transaxillary approach: an incision in the armpit to remove the first rib and relieve pressure
All approaches are effective. Patients typically go home the day after surgery with oral pain medication and return for follow-up within a few days.