Types of Thoracic Outlet Syndrome

NYU Langone doctors are experts at identifying thoracic outlet syndrome, which occurs when the arteries, veins, and nerves in the thoracic outlet, the space between the collarbone and the first rib, become compressed. There are three main types.

Neurogenic

The most common type of the condition, neurogenic thoracic outlet syndrome, is caused by the compression of the brachial plexus, a network of nerves that extend from the spine through the neck and into the arm. It tends to occur in people who perform repetitive overhead arm movements in their job or participate in certain sports, such as swimming or baseball. 

Neurogenic thoracic outlet syndrome can also develop in people who experience trauma to the neck or chest from a car accident or a fall. Sometimes, people with this condition are born with a misshapen first rib or a cervical rib, which is an extra rib located above the others. This can cause compression on the nerves in the area.

The resulting scar tissue may cause pain, numbness, tingling, headaches, or weakness in the arm and hand. 

Venous

Venous thoracic outlet syndrome is caused by the compression of a subclavian vein, which carries blood from the upper extremities—including the shoulders, arms, and hands—to the heart. This compression can lead to blood clots, which can travel to the heart and lungs and be life-threatening.

People with this condition are frequently born with a narrowing of the space where the subclavian vein extends from the shoulder to the heart. Overuse of the arm and shoulder, such as during sports or work, causes the veins in the thoracic outlet to become compressed, which can lead to blood clots.

Symptoms include swelling or bluish skin in the arms and swollen veins where the shoulder meets the chest.

Arterial

This type of thoracic outlet syndrome is caused by a blood clot in a subclavian artery, which carries blood from the heart to the arm. It occurs in people born with a cervical rib or an unusually shaped first rib, which can compress the subclavian artery. The repeated compression can lead to a permanent narrowing in the artery, causing clots to form and travel down the arm toward the hand.

Symptoms develop after a blood clot breaks apart and a piece of it flows into the arm, blocking circulation in the elbow or hand. Symptoms include coldness, numbness, pain, and tingling in the arm and hand. The hand or fingers may also appear white. Sometimes, the forearm and hand cramp during activity, such as when typing or exercising in a way that involves this arm.

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