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Thoracic Outlet Syndrome, Emergency Medicine

Adam J. Heringhaus and Daniel C. McGillicuddy Reviewed 06/2017



  • The symptoms of thoracic outlet syndrome (TOS) are produced by compression of the brachial plexus, subclavian vein, or subclavian artery during their passage from the cervical area t...


Signs and Symptoms

  • Neurogenic:

    • Classically, pain, paresthesia, and weakness of the hand, arm, and shoulder

    • May see wasting of the thenar eminence, also known as Gilliatt–Sumner hand

    • Analogous bu...


Ed Treatment/Procedures

  • Heparinization if signs of arterial or venous thrombosis

  • Vascular surgery consult for signs of ischemia and for catheter-directed thrombolysis if needed:

    • Anticoagulation...



Admission Criteria

  • Ischemia

  • Venous thrombosis

  • Arterial thrombosis

  • Arterial aneurysm or stenosis

  • Intractable pain

Discharge Criteria

  • Nonlimb-threatening neurologic findings

  • Absence of arte...

Pearls and Pitfalls

  • 3 types of TOS: Neurogenic, arterial, and venous:

    • Neurogenic is most common in adults.

    • ATOS and VTOS are the more common types in children and adolescents.

  • VTOS is the only type that ...

Additional Reading

  • Brantigan  CO, Roos  DB. Diagnosing thoracic outlet syndrome. Hand Clin.  2004;20(1):27–36.

  • Huang  JH, Zager  EL. Thoracic outlet syndrome. Neurosurgery.  2004;55(4):897–90...



353.0 Brachial plexus lesions 


G54.0 Brachial plexus disorders 


  • 128210009 thoracic outlet syndrome (disorder)

  • 2040007 Neurogenic thoracic outlet syndrome (disorder)

  • 128211008 Vascular...

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