Venous Thoracic Outlet Syndrome (TOS)

What is Venous Thoracic Outlet Syndrome (TOS)

Venous thoracic outlet syndrome is a condition that happens when the vein that returns blood from your arm and hand (subclavian vein) is squeezed (compressed). To reach your arm, the vein must pass through a tight space under your collarbone (clavicle) and above your top rib (thoracic outlet).

Depending on which structures are affected, you may have symptoms on one or both sides of your body.

What are the causes?

This condition may be caused by doing hard work with your arms, especially if you have to lift your arms above your head. A blood clot may form in the vein.

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Doing strenuous and repetitive work with your arms.
  • Being male.
  • Being overweight.
  • Having poor posture.

What are the signs or symptoms?

Symptoms of this condition include:

  • Pain and swelling of your whole arm.
  • Feeling of heaviness or tightness in your arm.
  • Weak or absent pulse in the affected arm.
  • Pale or gray skin on the affected arm.
  • In rare cases, some people may have muscle loss in their hands.

These signs and symptoms may be worse when you hold your arms over your head.

How is this diagnosed?

Your health care provider may suspect TOS from your symptoms. A physical exam will be done. During the exam, your health care provider may ask you to hold your arms over your head and in other positions to check whether your symptoms get worse. Tests may also be done to confirm the diagnosis and to find out what is causing TOS. These may include:

  • Imaging studies, such as:
    • X-rays to look for an extra rib at the base of your neck (cervical rib) or other abnormality of the ribs.
    • A test using sound waves to create an image (ultrasound).
    • CT scan.
    • MRI.
  • A test that involves measuring and recording the pulses in your wrists (pulse volume recording).
  • A test in which X-rays are done after dye is injected into your subclavian artery or vein (venogram or angiogram).

How is this treated?

This condition may be treated with:

  • Medicine, including blood thinners or blood clot dissolvers.
  • A procedure to open up the clotted vein and restore blood flow (angioplasty).
  • Surgery to remove a blood clot (thrombus).
  • Surgery to remove the uppermost rib to make more space in the thoracic outlet.

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Maintain a healthy weight. Lose weight as told by your health care provider.
  • Do stretching exercises as told by your health care provider or physical therapist.
  • Maintain good posture.
  • Do not carry heavy bags over your shoulder or repetitively lift heavy objects over your head.
  • Take frequent breaks to stretch and rest your arms if you work at a keyboard or do other repetitive work with your hands and arms.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have pain, cramps, numbness, or tingling in your arm or hand.
  • Your arm or hand often feels tired.
  • Your arm turns a darker and different skin color than usual.
  • Your hand feels cold.
  • You have frequent headaches or neck pain.
  • You have muscle loss in your hand.

Get help right away if:

  • You lose feeling in your arm or hand.
  • You cannot move your fingers.
  • Your fingers turn a dark color.

Summary

  • Venous thoracic outlet syndrome (TOS) is a condition that happens when the vein that returns blood from your arm and hand (subclavian vein) is squeezed (compressed).
  • This condition may be caused by doing hard work with your arms, especially if you have to lift your arms above your head.
  • Symptoms of this condition include pain and swelling of your whole arm, weak or absent pulse on the affected arm, and pale or gray skin on the affected arm.
  • Treatment may include medicines, a procedure to open up the clotted vein and restore blood flow (angioplasty), surgery to remove a blood clot (thrombus), or surgery to remove the uppermost rib to make more space in the thoracic outlet.
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