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Harvard Medical School
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General Medical Questions
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Question : What is thoracic outlet syndrome? Can it be treated?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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October 24, 2013
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The thoracic outlet refers to the junction of the neck, upper chest and arms through which important blood vessels and nerves travel. If that region is narrow, the nerves supplying the arm may get pinched or have less circulation. This may cause numbness, tingling, pain or swelling in the arm. This condition is called thoracic outlet syndrome. And it has a number of causes.

The most common causes: 

  • Sagging muscles (related to aging, obesity, or large, heavy breasts).
  • Abnormal posture (for example, as may happen with scoliosis).

Less common causes include wearing a heavy backpack, trauma or the presence of an extra rib.

In the past, some doctors questioned whether the syndrome even existed because routine exams and tests may be normal. But the symptoms were still present. It is likely that the condition does exist but is probably rare.

Diagnosis requires a mix of the following:

  • Known symptoms of the condition. The most common are numbness, tingling, clumsiness or swelling in one arm without another explanation.
  • An abnormal finding during an examination. The exam should include maneuvers to increase pressure in the thoracic outlet. For example, when standing with the shoulders as far back and downward as possible, the pulse at the wrist may decrease or numbness may develop.
  • A chest X-ray or ultrasound. This can identify a narrowed thoracic outlet or a cause for the condition (such as an extra rib).

Treatment options include simple measures to reduce pressure in the thoracic outlet, such as:

  • Efforts to improve posture and relax the muscles of the neck, thorax and shoulder.
  • Weight loss, if needed.
  • A support bra for women.  

Physical therapy is also helpful in a majority of affected people.

In rare cases, doctors recommend surgery to “open up” the thoracic outlet. It may be appropriate when:

  • The doctor concludes that it is the most likely diagnosis.
  • Other causes of symptoms have been ruled out.
  • More conservative therapies have failed.
  • There are severe symptoms or signs of poor circulation, nerve injury or muscle wasting.

Speak with your doctor about your symptoms, and which treatment may be right for you.

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