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General Medical Questions
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Question : What type of doctor would be best to treat thoracic outlet syndrome?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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January 27, 2011
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A:

First, you must be sure that your symptoms are definitely caused by thoracic outlet syndrome. This condition is rare.

The “thoracic outlet” refers to an opening at the junction of the neck, upper chest and arms through which important blood vessels and nerves travel. If that region is narrow, there may be reduced circulation or a pinching of the nerves to the arm. When symptoms occur, it is called thoracic outlet syndrome.

A person with thoracic outlet syndrome may have one or more of these symptoms in the arm and/or hand:

  • Pain
  • Tingling
  • Numbness
  • Weakness
  • Swelling

Most often these symptoms are related to some cause other than thoracic outlet syndrome.

I suggest that you first talk with your doctor. To start, diagnosing thoracic outlet syndrome requires a combination of the following:

  • Pain, numbness, tingling, clumsiness and/or swelling in one arm without another explanation
  • An abnormal finding during an examination that tests if you have an increase in pressure in the thoracic outlet. For example, when standing with your shoulders as far back and downward as possible, your doctor will check if the pulse at your wrist decreases or you have any numbness.

If the diagnosis seems likely, I would next refer you to a neurologist. He or she will repeat the physical examination and likely order special testing of your nerve function.

Treatment options include simple measures to reduce pressure in the thoracic outlet. This can include improving posture; relaxing the muscles of the neck, thorax and shoulder; losing weight; or wearing a support bra. Physical therapy is usually helpful.

Surgery to “open up” the thoracic outlet is needed in less than 10% of cases. It may be appropriate when the diagnosis has been well established, other causes of the symptoms have been ruled out and the more conservative therapies mentioned above have failed.

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