Specialties

Thoracic Outlet Syndrome

Comprehensive evaluation and individualized surgical care for all three types of thoracic outlet syndrome.

What Is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is a group of disorders that occur when nerves, arteries, or veins in the thoracic outlet — the space between the collarbone and the first rib — become compressed. This compression can cause pain, numbness, weakness, and circulatory problems in the shoulder, arm, and hand.

TOS is frequently underdiagnosed. Its symptoms often overlap with other conditions, and accurate diagnosis requires a thorough clinical evaluation by a surgeon with specific experience in the disorder. Our team has dedicated a significant portion of our practice to TOS and has extensive experience across all three subtypes.

Treatment is individualized based on the type of TOS, the severity of symptoms, and the patient's anatomy. Surgical intervention — when indicated — can provide durable relief and restoration of function.

Types of Thoracic Outlet Syndrome

We evaluate and treat all three subtypes of TOS, each involving different structures and requiring a tailored surgical approach.

Neurogenic TOS

Nerve compression

The most common form, neurogenic TOS involves compression of the brachial plexus. Symptoms include pain, numbness, tingling, and weakness in the arm and hand. Surgical treatment typically involves first rib resection and scalenectomy to decompress the brachial plexus.

Treatments

First rib resection
Scalenectomy
Brachial plexus neurolysis

Venous TOS

Paget-Schroetter Syndrome

Venous TOS involves compression or thrombosis of the subclavian vein, often presenting as sudden arm swelling, heaviness, and discoloration — particularly in young, active patients. Treatment typically combines thrombolysis with surgical decompression.

Treatments

Catheter-directed thrombolysis
First rib resection
Venous reconstruction if needed

Arterial TOS

Subclavian artery involvement

The least common but most serious form, arterial TOS involves compression of the subclavian artery, which can lead to aneurysm formation, thrombosis, or distal embolization. Surgical treatment addresses both the compression and any arterial damage.

Treatments

First rib resection
Subclavian artery reconstruction
Embolectomy if indicated

Diagnosis

Accurate diagnosis of TOS requires a careful history, physical examination, and targeted diagnostic studies. Because TOS symptoms can mimic other conditions — including cervical disc disease, carpal tunnel syndrome, and rotator cuff pathology — a thorough evaluation by an experienced surgeon is essential.

Our evaluation typically includes a detailed clinical assessment, provocative maneuvers, and imaging studies as indicated. For venous and arterial TOS, duplex ultrasound, CT angiography, or venography may be used to characterize the extent of vascular involvement.

We work closely with referring physicians to ensure a thorough workup and clear communication of findings and recommendations.

Surgical Treatment

When surgery is indicated, our approach is individualized to the patient's anatomy, TOS subtype, and clinical presentation. The cornerstone of surgical treatment for most forms of TOS is first rib resection — removing the first rib to decompress the thoracic outlet.

This is typically performed via a transaxillary or supraclavicular approach, depending on the clinical situation. Scalenectomy — removal of the anterior and/or middle scalene muscles — is often performed in conjunction with rib resection for neurogenic TOS.

First rib resection (transaxillary or supraclavicular)
Scalenectomy
Subclavian artery reconstruction
Subclavian vein reconstruction
Brachial plexus neurolysis
Embolectomy for arterial TOS

Refer a Patient or Request a Consultation

We welcome referrals from physicians throughout south Louisiana and southwest Mississippi. If you have a patient with suspected TOS or a confirmed diagnosis requiring surgical evaluation, contact our office and we will coordinate promptly.