Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome is a group of disorders that occur when the nerves or blood vessels in the space between your collarbone and your first rib become compressed. 


  • Pain in neck, shoulder and/or arm.

  • Symptoms worsen with repetitive or overhead activities.

  • Numbness and tingling of the fingers.

  • Gradual loss of strength in the hand and arm.

  • Coldness in the hands and fingers

  • Headaches

Conservative Treatment

  • Alter activities to avoid putting your hands over head, and practice good posture.

  • Occupational Therapy treatment which includes stretching your neck muscle (anterior scalene) and strengthening your shoulder girdle muscles (trapezium, rhomboid and serratus anterior).

  • Rule out possibility of cervical spine problem through diagnostic testing.


  • If symptoms have not improved after months of occupational therapy, then surgery is recommended.

About the Surgery

  • Removal of a segment of the anterior scalene muscle (or resection of a rib if the congenital abnormality exists).

  • A 3-4 cm incision is made above the collar bone.

  • The surgery takes 40-60 minutes.

  • General anesthesia is used.

  • Surgery does not require an overnight stay at a hospital.  The procedure may be performed as an outpatient.  

What causes Thoracic Outlet Syndrome?

  • Five nerve roots from your cervical spine join together to form a nerve bundle called the Brachial Plexus.  The Brachial Plexus enters the arm through neck muscles.  Some of the neck muscles can be a source of compression.  Raising the arm above the head further compresses these nerves, decreasing their intrinsic blood flow transport of essential components to maintain a healthy nerve which results in symptoms.

  • Congenital abnormalities may result in an extra cervical rib in the middle of the brachial plexus.

The staff at Bel Air Center for Plastic and Hand are always happy to address any of your questions.  We understand that every patient is unique, and specifically aim to cater our care to reflect our patients' needs.  



Bel Air South Professional Center

2012 South Tollgate Road, Suite 100

Bel Air, MD 21015

Ramon A. DeJesus, M.D., FACS

Mathew A. Thomas, M.D.

Eric Davies, PA-C

Rachel Pigott, OT, CHT

Stefanie Stevenson, OT, CHT

Affiliated with:

University of Maryland Upper Chesapeake Health

University of Maryland

Johns Hopkins University

Office Hours:

M-F  8:00am - 4:00 pm