Arterial thoracic outlet syndrome (TOS) is a rare form of TOS that occurs when the subclavian artery is compressed, leading to compromised blood flow to the arm.
This can result in symptoms such as pain, coldness, and color changes in the affected limb.
Arterial TOS is often caused by anatomical abnormalities, trauma, or repetitive strain.
Accurate diagnosis through medical evaluation and imaging tests is crucial for effective treatment, which may involve medications, surgical intervention, and lifestyle modifications.
Thoracic outlet syndrome care at WashU Medicine
Vascular surgeons at WashU Medicine see patients at Barnes-Jewish Hospital, one of the top hospitals in the nation for heart and vascular care. Our team has the experience to treat even the rarest and most complex cases. That’s why people come from across the country for expert care from WashU Medicine physicians.
What is arterial thoracic outlet syndrome?
Arterial thoracic outlet syndrome is the least common type of TOS, characterized by compression of the subclavian artery. This compression restricts blood flow to the arm, leading to a variety of symptoms, including pain, coldness, and changes in skin color in the affected arm. Due to its potential severity, arterial TOS requires prompt medical attention and intervention.
The subclavian artery is a major blood vessel that supplies blood to the upper extremities, head, and neck.
Learn more: What is thoracic outlet syndrome?
Arterial TOS causes
Several factors can contribute to the development of arterial TOS, including:
Anatomical abnormalities
- Cervical ribs: Extra ribs originating from the cervical spine can compress the subclavian artery.
- Fibromuscular bands: Tight bands of muscle or ligament can obstruct arterial flow.
- Congenital defects: Structural abnormalities present at birth that affect the thoracic outlet.
Trauma
- Injuries: Trauma from accidents or falls can lead to compression of the subclavian artery.
- Repetitive strain: Continuous overhead activity or repetitive arm movements can contribute to arterial TOS.
Poor posture
- Slouching: Maintaining poor posture, particularly with drooping shoulders, can place stress on the thoracic outlet.
- Prolonged postures: Extended periods in certain postures can exacerbate arterial compression.
Other factors
- Tumors: Rarely, growths within the thoracic outlet may compress the subclavian artery.
- Obesity: Excess weight can increase pressure on the thoracic outlet area.
Arterial TOS symptoms
Symptoms of arterial TOS can be severe and may include:
Pain
- Severe pain: Intense pain in the neck, shoulder, or arm due to restricted blood flow.
- Pain on activity: Increased pain during physical activities involving the affected limb.
Circulatory symptoms
- Coldness: The affected arm may feel unusually cold due to reduced blood flow.
- Paleness: Changes in skin color, including paleness, may occur in the affected arm.
- Weak pulse: A noticeably weak or absent pulse in the affected arm.
Other symptoms
- Numbness: Tingling or numbness in the arm or hand.
- Fatigue: Feeling of heaviness or fatigue in the arm, particularly after activity.
Arterial TOS diagnosis
Diagnosing arterial TOS involves a thorough medical evaluation, including:
Medical history
Your doctor will inquire about your symptoms, medical history, and activities that may contribute to arterial TOS.
Physical examination
A physical exam will assess pain, color changes, and pulse strength in the affected arm. Specific maneuvers may be used to reproduce symptoms and identify the compression site.
Imaging tests
Imaging tests may include:
- Ultrasound: To visualize the subclavian artery and check for signs of compression or occlusion.
- Arteriogram: An X-ray of the arteries using a contrast dye to highlight obstructions or narrowing.
- MRI or CT scans: Detailed images to identify anatomical abnormalities causing arterial compression.
Blood tests
Blood tests may be conducted to identify markers of inflammation or other abnormalities affecting blood flow.
Arterial TOS treatment
Treatment for arterial TOS depends on the severity of symptoms and underlying causes, and may include:
Conservative treatments
- Medications: Anti-inflammatory drugs and blood thinners to manage symptoms and prevent complications.
- Physical therapy: Exercises to improve posture, increase circulation, and reduce compression.
- Lifestyle modifications: Adjustments to activities and postures to alleviate symptoms.
Surgical treatment
In severe cases or when conservative treatments are ineffective, surgery may be necessary:
- Arterial decompression: Surgical removal of structures compressing the subclavian artery.
- First rib resection: Removal of the first rib to relieve arterial compression.
- Vascular reconstruction: Procedures to repair or replace damaged segments of the subclavian artery.
Living with arterial thoracic outlet syndrome
Managing arterial TOS requires a comprehensive approach involving medical intervention, physical therapy, and lifestyle changes. Maintaining good posture and avoiding activities that worsen symptoms are crucial.
Early diagnosis and appropriate treatment significantly improve outcomes and help prevent complications.
If you suspect you have arterial TOS or have been diagnosed with the condition, seeking medical advice from a health care professional is essential. Appropriate treatment and management can effectively control symptoms and enhance your quality of life.
