Types of Thoracic Outlet Syndrome

NYU Langone doctors from the Thoracic Outlet Syndrome Program are experts in 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, venous, and arterial thoracic outlet syndrome.

Neurogenic Thoracic Outlet Syndrome

The most common type, 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. Many people who have neurogenic thoracic outlet syndrome can be treated with highly specialized physical therapy.

Venous Thoracic Outlet Syndrome

Venous thoracic outlet syndrome is caused by the compression of a subclavian vein, a vein under the collarbone that 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. Patients often have a swollen and painful arm, with dark-blue discoloration, resulting from dilated veins filled with blood clots.

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.

Doctors may recommend anticoagulants, commonly known as blood thinners, and a minimally invasive procedure to remove most of the clots within the veins. Once clots are removed, the compression can be simultaneously diagnosed using imaging tests such as venography or MRI scans. After clot removal, most patients benefit from removal of the first rib.

Arterial Thoracic Outlet Syndrome

This type of thoracic outlet syndrome is caused by compression of the subclavian artery, which is the main artery from the chest to the arm. The condition can be the result of a large first rib or an abnormal cervical rib. Repeated compression can lead to a trauma in the artery, causing formation of clots, which can travel down the arm toward the hand. This can also lead to aneurysms forming in the subclavian artery.

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 turn white when the subclavian artery is compressed.

Treatment may require removal of blood clots, reconstruction of the artery, and removal of the first rib or cervical rib.