Which specialist should you see for suspected thoracic outlet syndrome?
Ask the doctor
Q. What type of doctor would be best to treat thoracic outlet syndrome?
A. First, you must be sure that your symptoms are definitely caused by thoracic outlet syndrome. This condition is rare.
The thoracic outlet refers to an opening at the junction of the neck, upper chest, and arms through which important blood vessels and nerves travel. If that region is narrow, there may be reduced circulation or a pinching of the nerves to the arm. When symptoms occur, it is called thoracic outlet syndrome.
A person with thoracic outlet syndrome may have one or more of these symptoms in the arm and/or hand:
- pain
- tingling
- numbness
- weakness
- swelling.
Most often, these symptoms are related to some cause other than thoracic outlet syndrome.
I suggest that you first talk with your doctor. To start, diagnosing thoracic outlet syndrome requires one or both of the following:
- pain, numbness, tingling, clumsiness, and/or swelling in one arm without another explanation
- an abnormal finding during an examination that tests if you have an increase in pressure in the thoracic outlet; for example, when standing with your shoulders as far back and downward as possible, your doctor will check if the pulse at your wrist decreases or you have any numbness.
If the diagnosis seems likely, you might need to see a neurologist if the symptoms are primarily pain and numbness, or a vascular surgeon if there is potential impingement of arterial or venous blood flow. Some medical centers have a specific specialty office that can provide a comprehensive evaluation of symptoms suggestive of thoracic outlet syndrome.
Treatment options include simple measures to reduce pressure in the thoracic outlet. This can include improving posture; relaxing the muscles of the neck, thorax, and shoulder; losing weight; or wearing a support bra. Physical therapy is usually helpful.
Surgery to "open up" the thoracic outlet is needed in less than 10% of cases. It may be appropriate when the diagnosis has been well established, other causes of the symptoms have been ruled out, and the more conservative therapies mentioned above have failed.
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About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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