Diagnosing Thoracic Outlet Syndrome

The thoracic outlet is the space between the collarbone and the first rib. The nerves, arteries, and veins in this area serve the arms and hands. When they become compressed, you have thoracic outlet syndrome. NYU Langone doctors are experts at providing an accurate diagnosis for this relatively rare condition.

Symptoms of thoracic outlet syndrome include arm pain and swelling, which may be caused by blood clots. You may also feel an ache in the neck or shoulders, or tingling or numbness in the affected arm or fingers. A bluish tinge or a noticeable lack of color in the hand may appear. Some people with thoracic outlet syndrome have a weak or absent pulse in the arm, cold hands or fingers, and a throbbing lump near the collarbone, which may be a sign of a blood clot.

This condition tends to occur in people who perform repetitive arm motions at work or while participating in sports such as swimming, baseball, and tennis. Some people are born with an extra rib, called a cervical rib, which can narrow the opening in the thoracic outlet and lead to compression. For others, a car accident or other injury causes the condition. 

Your NYU Langone doctor takes a medical history to learn about your symptoms. He or she also performs a physical exam to check for swelling, distended veins, unusual skin color, or cold hands.

The doctor may also order one or more imaging tests to diagnose thoracic outlet syndrome. 

Body Maneuvering Tests

You may be asked to reproduce your symptoms by putting your neck, arms, or hands in various positions. Symptoms may include pain, weakness in a finger or limb, and fatigue in the arms, hands or both. You may also feel tenderness or discoloration in the hands.

This body maneuvering test can help identify the type of thoracic outlet syndrome you have.

Chest X-rays

A chest X-ray creates pictures of the body to help identify any abnormalities in the bones, including an extra, or cervical, rib or an unusually small thoracic outlet. 

Arterial Duplex Ultrasound

The arterial duplex ultrasound test combines Doppler and conventional ultrasound. Doppler ultrasound uses sound waves to produce color images of the body. Your doctor may use this test to assess blood flow in the arteries in the thoracic outlet. This helps the doctor to identify any blockages or compression.

During the ultrasound, the doctor places a hand-held instrument, called a transducer, against your skin. The transducer transmits sound waves that produce images of blood vessels on a computer monitor and overlays this with a color image of the arteries and veins. The test may take 30 to 45 minutes. 

CT Scans

A CT scan uses X-rays and a computer to create three-dimensional, cross-sectional images of the body. Your NYU Langone doctor may order this test even if a chest X-ray indicates there are no problems with the thoracic outlet. He or she may want to obtain a more detailed view of the area for evidence of a blood vessel blockage or compression. 

Just before the scan begins, you may be given an intravenous (IV) dose of a saline solution that contains a contrast material, or dye. The liquid travels through blood vessels and highlights any blockages in the arteries.

A chest CT scan typically takes 30 to 45 minutes. You may feel a warm sensation throughout your body if you were given a contrast dye. 

MRI Scans

An MRI scan uses a magnetic field and radio waves to create computerized, two- and three-dimensional images of the body. It helps doctors determine if any chest veins and arteries are blocked or compressed. 

Before the test begins, a technician may inject a contrast dye, which highlights the thoracic outlet. You may feel a warm sensation as the dye travels throughout your body. 

The test takes up to 45 minutes to complete. 

Arteriography or Venography

X-rays of the arteries are called arteriography, and X-rays of the veins are called venography. In this test, a contrast dye is injected into the arteries or veins, enabling your doctor to clearly see any blockages.

Our specialists use a local anesthetic to perform the procedure and may recommend a sedative for comfort. 

In an arteriogram, your doctor makes a small incision in the leg, then places a catheter in the femoral artery, which is located in the thigh. In a venogram, a needle puncture is made in the arm to reach the subclavian vein, which is located under the collarbone and carries blood to the heart. 

The doctor guides the catheter through the arteries or veins to the thoracic outlet and injects contrast material into it. This allows him or her to clearly view arteries and veins on a computer monitor. 

Technicians take several sets of X-rays during the procedure, which may take one or several hours. The length of time it takes depends on what your doctor finds and the type of treatment, which may include the use of thrombolytic medications or procedures such as balloon angioplasty or venoplasty to dislodge any blood clots.

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