Conditions We Treat

A nerve is pulled from the spinal cord and is unlikely to recover function; often requires alternative types of surgery to gain function.

A Brachial plexus birth injury is when the infants’ neck is stretched to the side during a difficult delivery. Damaged nerves cause lack of movement and feeling in baby’s arm and hand and cause lack of grip.

A nerve that runs from the forearm into the palm becomes compressed or squeezed at the wrist; causes numbness, weakness and pain.

The ulnar nerve, which runs from the neck down the arm into the hand, is compressed or irritated; causes numbness and tingling.

Pressure on a nerve by surrounding tissues such as bone, cartilage, muscles or tendons; causes pain, numbness and weakness.

• Schwannomas: Rare nerve tumors that form in the nervous system (usually not cancerous); cause numbness, weakness, tingling and pain.
• Neurofibromas: Tumors of the nerve fibers.

A buildup of nerve scar tissue after a stretched nerve has tried to heal itself. This buildup prevents movement and function and may require surgery.

A stretch to a nerve, usually resolves on its own with time.

Damage to the nerves that branch off from the brain and spinal cord. Often the result of a traumatic accident, fall, sports injury or issue during a surgery.

Tumors that form in the tissue that covers and protects the nerves. These tumors are usually not cancerous, but can cause pain and movement issues.

The nerve is stretched beyond tolerance. A rupture or a tear may occur along the nerve itself and can cause loss of feeling and movement. Surgery is often required to recover function.

Patients with Thoracic Outlet Syndrome most often complain of pain that extends down the arm and in the hand (specifically the ring finger and pinky). It also can involve pain in the forearm and upper arm. Typically, this pain is sharp, burning or aching and causes numbness or tingling.

Thoracic Outlet Syndrome can affect adults and children of all ages and genders, though it tends to not become prevalent until the teenage years and into adulthood. It also can develop spontaneously during middle age, when it is seen more commonly in women than men because of poor muscular development and posture. It can be common among those who are tall and thin, as with those who have Ehlers-Danlos syndrome.

Thoracic outlet syndrome also may affect those who participate in sports requiring repetitive motions of the arms and shoulders. They include swimmers, volleyball players, baseball players and weight lifters. Sports are not the only activity that may result in this syndrome. The repetitive motions required to play stringed musical instruments and to work in carpentry and construction also can cause thoracic outlet syndrome. 

Thoracic Outlet Syndrome often is diagnosed with a neurological exam during which the arm is placed in different positions so symptoms can be reproduced. This helps us determine whether the syndrome is caused by compression of the nerves of the brachial plexus (neurogenic) or by the compression of the subclavian artery or vein (vasogenic), which is located in the neck.

With this kind of exam, doctors sometimes see changes in sensation, motor function and adequate blood flow (decrease in the pulses when arms are elevated above the head).

Imaging and other studies also may be necessary. X-rays and computerized tomography (CT) scans can be used to evaluate for congenital issues like the presence of cervical or other anomalous ribs that can compress the nerves. Magnetic resonance imaging (MRI) – especially using MR arteriography (MRA) or MR venography (MRV) – also can be useful because it can show variation in the blood vessels or nerves. This is evidence of compression, particularly when the imaging is obtained in the positions that cause the symptoms (for example, arms raised above the head).

Treatment of Thoracic Outlet Syndrome most often involves physical and occupational therapy, along with medicines for symptomatic pain relief. However, in the 10–20% of cases that don’t improve with those treatments, thoracic outlet surgery can be used to increase the space in which the blood vessels and nerves pass through the thoracic outlet.

Surgery for the treatment of Thoracic Outlet Syndrome involves creating more room for the nerves and/or blood vessels to pass from the neck to the arm underneath the clavicle, or collarbone. This may involve removing scar tissue, detaching parts of the scalene muscles and/or removal of the cervical, or first, rib.

This is an outpatient procedure that allows patients to go home the same day, usually just an hour or two after surgery. The outcomes of surgical treatment for thoracic outlet syndrome are good, with up to 80% of patients experiencing improvement in symptoms.