Four questions about thoracic outlet syndrome answered

Four questions about thoracic outlet syndrome answered

Signs, risk factors and treatment options

Friday, October 27, 2017

Sapan Desai, M.D., Ph.D., M.B.A., NCH Medical Director of Surgical Quality, Board-Certified General and Vascular Surgeon

What are the presenting signs for a patient with thoracic outlet syndrome?

Thoracic outlet syndrome (TOS) has three different presentations, including an arterial, venous and neurogenic version. The neurogenic version is by far the most common (more than 90 percent of diagnoses), and presents with numbness, tingling and weakness in the arm that gets worse over a period of months or years. Patients complain of a change in quality of life. Often, patients undergo carpal tunnel surgery or an ulnar nerve release thinking this will solve their issues, but the symptoms remain despite these interventions.

Who can get TOS?

TOS primarily affects people between the ages of 20 and 55. Common risk factors include trauma to the neck or shoulder, repetitive stress injuries, prolonged manual labor and a genetic predisposition to the disease. Anyone can get TOS, and severe permanent neurological injury is possible if the condition is not treated.

What should I do if I think my patient has TOS?

Management of TOS can be complex and involves close follow up by an experienced practitioner. Some patients may need surgery, and this meticulous operation can last several hours. A practitioner who is experienced in the treatment of the disease can achieve a significant improvement in the quality of life for their patients. If you think your patient has signs or symptoms of TOS, consider referring them to an authority in this area.

What does surgery involve?

Surgery for TOS involves a small, strategically placed incision just behind the collar bone. Hypertrophic, diseased muscles in the neck (the scalene muscles) are removed, and occasionally, a portion of the first rib is also excised. Scar tissue around the nerves is stripped away. Most patients being treated for neurogenic TOS can have their operation completed in about 90 minutes, and many will be discharged home within one to two days. Many people report an immediate improvement in their symptoms.

About Dr. Desai

Dr. Desai is a board-certified general and vascular surgeon exclusively with Northwest Community Healthcare. He has performed numerous complex operations for TOS. He is the author of more than 200 papers, presentations and textbooks in surgery and healthcare quality. He also has contributed to a textbook on TOS, and has written several abstracts and papers on the topic. He was most recently invited to present his research in this area at a major vascular surgery conference.

More information and consultations

See more information on our Vascular Program. To refer a patient, call 847-618-3800.