Symptoms of Neurogenic-Arterial Thoracic Outlet Syndrome

  • J. Ernesto Molina


Commonly the symptoms associated with neurogenic compression are pain, paresthesias, numbness, tingling, and, occasionally, weakness of the hand muscles of the involved arm. Less frequently, associated arterial compression may produce paleness of the arm particularly when it is elevated to 90° or 180° of abduction [1–11]. These symptoms may be present for months or sometimes even years without producing any complications. As the symptoms progress, however, the entire hand and sometimes part of the forearm may become involved. Over 85 % of patients with advanced disease complain of pain, numbness, and tingling of the hand and fingers [8, 9, 12–14]. All of them, however, will complain of a throbbing type of pain involving the entire arm, including the forearm and the hand, when the arm is abducted 90° to the shoulder level, or above that level (i.e., when they try to reach over their heads). Many times the patients cannot raise the arm over their head because of the tightening and pain experienced not only around the forearm but also around the shoulder, extending on occasion to the back at the base of the neck. As the symptoms become more severe patients may have difficulty driving their vehicles because they are unable to maintain their arms on the steering wheel preferring to keep them in their laps. Discomfort of this severity is present in 100 % of cases and causes most patients to seek medical attention. The patients who suffer concomitantly from subclavian artery compression demonstrate immediate paleness of the hand upon elevation of the arm over their heads which rapidly returns to normal as it is lowered.


Carpal Tunnel Syndrome Brachial Plexus Subclavian Artery Carpal Tunnel Hand Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Leffert RD. Thoracic outlet syndromes. Hand Clin. 1992;8:285–97.PubMedGoogle Scholar
  2. 2.
    Bertelsen S. Neurovascular compression syndromes of the neck and shoulder. Acta Chir Scand. 1969;135:137–48.PubMedGoogle Scholar
  3. 3.
    Mackinnon S, Patterson GA, Urschel Jr HC. Chapter 52: Thoracic outlet syndromes. In: Thoracic surgery. 2nd ed. New York: Churchill Livingston; 2002. p. 1393–415.Google Scholar
  4. 4.
    Capistrant TD. Thoracic outlet syndrome cervical strain injury. Minn Med. 1986;69:13–7.PubMedGoogle Scholar
  5. 5.
    Telford ED, Mottershead S. The “Costoclavicular Syndrome”. Br Med J. 1947;15:325–8.CrossRefGoogle Scholar
  6. 6.
    Griffth Pearson F. Chapter 50: Thoracic outlet syndrome. In: Mackinnon S, Patterson GA, editors. Thoracic surgery. New York: Churchill Livingston; 1995. p. 1294–8.Google Scholar
  7. 7.
    Urschel Jr HC, Razzuk MA. Chapter 18: Thoracic outlet syndrome. In: Sabiston DC, Spencer F, editors. Surgery of the chest. 5 (7 and 8)th ed. Philadelphia: Saunders; 1990. p. 536–53.Google Scholar
  8. 8.
    Rosati LM, Lord JW. Neurovascular compression syndromes of the shoulder girdle, Modern surgical monograph. New York: Grune & Stratton Inc; 1961. pp 168.Google Scholar
  9. 9.
    Altobelli GG, Kudo T, Haas BT, Chandra FA, Moy JL, Ahn SS. Thoracic outlet syndrome: pattern of clinical success after operative decompression. J Vasc Surg. 2005;42:122–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Keen WW. The symptomatology, diagnosis and surgical treatment of cervical ribs. Am J Med Sci. 1907;133(2):173–218.CrossRefGoogle Scholar
  11. 11.
    Murphy T. Brachial neuritis caused by pressure of first rib. Aust Med J. 1910;25:582–6.Google Scholar
  12. 12.
    Molina JE. Combined posterior and transaxillary approach for neurogenic thoracic outlet syndrome. J Am Coll Surg. 1998;187:39–45.PubMedCrossRefGoogle Scholar
  13. 13.
    Morley J. Brachial plexus neuritis due to a normal first thoracic rib: its diagnosis and treatment by excision of rib. Clin J. 1913;42:461–8.Google Scholar
  14. 14.
    Urschel Jr HC, Paulson DL, McNamara JJ. Thoracic outlet syndrome. Ann Thorac Surg. 1968;6:1–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Chapter 12: Cervical rib and thoracic outlet compression and other causes of upper limb occlusion. In: Eastcott HHG, editor. Arterial surgery. London: Pitman Med Publ; 1971. p. 216–34.Google Scholar
  16. 16.
    Urschel Jr HC. Chapter 19: Thoracic outlet syndromes. In: Kaiser LR, Kron IL, Spray FL, editors. Mastery of cardiothoracic surgery. Philadelphia: Lippincott-Raven; 1998. p. 178–85.Google Scholar
  17. 17.
    Ferguson TB, Burford TH, Roper CL. Neurovascular compression at the superior thoracic aperture. Surgical management. Ann Surg. 1968;167:573–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Loh CS, Wu AV, Stevenson IM. Surgical decompression for thoracic outlet syndrome. J R Coll Surg Edinb. 1989;34:66–8.PubMedGoogle Scholar
  19. 19.
    Molina JE, D’Cunha J. The vascular component in neurogenic-arterial thoracic outlet syndrome. Int J Angiol. 2008;17:83–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • J. Ernesto Molina
    • 1
  1. 1.Division of Cardiothoracic SurgeryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations