Your doctor may recommend a thorough evaluation by a skilled neurologist to rule out cervical spine disease and other neurological conditions with similar symptoms. Additional tests that help diagnose thoracic outlet syndrome include:.
Most cases of neurogenic thoracic outlet syndrome can be treated with physical therapy and medication. Severe cases may require surgery. Physical Therapy Physical therapy includes a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights to pull the outlet into a "relaxed" open position.
Physical therapy may be done before surgery, as in the case of neurogenic TOS, or may be prescribed after surgery to help you regain strength and stability. You may feel a warm sensation as the dye travels throughout your body. X-rays of the arteries are called arteriography, and X-rays of the veins are called venography. In this test, a contrast dye is injected into the arteries or veins, enabling your doctor to clearly see any blockages.
Our specialists use a local anesthetic to perform the procedure and may recommend a sedative for comfort. In an arteriogram, your doctor makes a small incision in the leg, then places a catheter in the femoral artery, which is located in the thigh.
In a venogram, a needle puncture is made in the arm to reach the subclavian vein, which is located under the collarbone and carries blood to the heart.
The doctor guides the catheter through the arteries or veins to the thoracic outlet and injects contrast material into it.
This allows him or her to clearly view arteries and veins on a computer monitor. Technicians take several sets of X-rays during the procedure, which may take one or several hours.
The length of time it takes depends on what your doctor finds and the type of treatment, which may include the use of thrombolytic medications or procedures such as balloon angioplasty or venoplasty to dislodge any blood clots.
We can help you find a doctor. Call or browse our specialists. If you need help accessing our website, call Skip to main content. Diagnosing Thoracic Outlet Syndrome. To diagnose thoracic outlet syndrome, your doctor may review your symptoms and medical history and conduct a physical examination.
Provocation tests are designed to try to reproduce your symptoms. The tests may help your doctor determine the cause of your condition and help rule out other causes that may have similar symptoms.
In these tests, your doctor may ask you to move your arms, neck or shoulders in various positions. Your doctor will check your symptoms and examine you in different positions. To confirm the diagnosis of thoracic outlet syndrome, your doctor may order one or more of the following tests:.
Arteriography and venography. In these tests, your doctor inserts a thin, flexible tube catheter through a small incision, usually in your groin. The catheter is moved through your major arteries in arteriography, or through your veins in venography, to the affected blood vessels. Then your doctor injects a dye through the catheter to show X-ray images of your arteries or veins. Doctors can check to see if you have a compressed vein or artery. If a vein or artery has a clot, doctors can deliver medications through the catheter to dissolve the clot.
Our caring team of Mayo Clinic experts can help you with your thoracic outlet syndrome-related health concerns Start Here. In most cases, a conservative approach to treatment is effective, especially if your condition is diagnosed early. Treatment may include:. Your doctor may recommend surgery if other treatment hasn't been effective, if you're experiencing ongoing symptoms or if you have progressive neurological problems. A surgeon trained in chest thoracic surgery or blood vessel vascular surgery will perform the procedure.
Thoracic outlet syndrome surgery has risks of complications, such as injury to the brachial plexus. Also, surgery may not relieve your symptoms, and symptoms may recur. Lum and his associates are researching ways to improve more accurate detection of TOS and prompt referral. He is also interested in research to determine patient selection to yield the best functional outcomes.
Recent research supports completely removing the first rib to prevent recurrence of symptoms in neurogenic TOS. Skip Navigation. Published in Summer
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