The Massachusetts General Hospital Division of Thoracic Surgery's Thoracic Outlet Syndrome Program provides diagnosis, treatment and support to patients with thoracic outlet syndrome and related conditions.

What to Expect

A single test can rarely confirm a TOS diagnosis. Mass General thoracic surgeons design examination programs tailored to individual patients. Our TOS diagnoses are established by ruling out other disorders and then testing to see if the condition involves the nerves (neurogenic TOS) or the blood vessels (vascular TOS).

Our rigorous clinical assessment begins with a detailed history and physical examination. Additional examinations are tailored to individual patients' needs and may include:

• Magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and computed tomography (CT) to develop images of the thoracic outlet and cervical spine
• Ultrasound-guided injections into the muscles involved in narrowing the thoracic outlet, which surround the brachial plexus
• Noninvasive vascular studies
• Nerve-conduction studies, or electromyography

Multiple specialists bring a broad range of expertise to the patient’s care.

In almost all cases, our initial treatment includes a physical therapy program tailored to the individual patient, with exercises specific to TOS. Patients are referred to the Mass General Department of Physical and Occupational Therapy, where therapists perform a functional assessment and design an individualized program. Patients who have not shown improvement in other physical therapy programs have often improved with our physical therapists. Most of our patients do not require surgery to improve their symptoms.

For patients who do require surgery, the procedure may involve removal of the first rib and division or removal of the anterior scalene muscle in the neck. Patients with vascular TOS may require repair of veins and arteries. The average stay at Mass General following surgery is one or two days.

New Evaluation Strategies & Exercises

Our team has developed two new evaluation strategies that build upon the standard MRI and CT technologies. We recalibrated each technology to develop images that are more detailed than previously available, providing a more accurate diagnosis. In another project, Mass General worked with physical therapists to craft individual exercises specifically to help patients with TOS.

To make an appointment, please contact the program at 617-724-0969.

The Massachusetts General Hospital Division of Thoracic Surgery's Thoracic Outlet Syndrome Program provides diagnosis, treatment and support to patients with thoracic outlet syndrome and related conditions.

Thoracic outlet syndrome (TOS) is caused by pressure on the nerves of the brachial plexus, or the blood vessels just behind the collarbone. Patients' symptoms usually vary, but may include pain and tingling in the arm, neck, shoulder, upper chest and back.

A Leading Referral Center

Our program attracts patients from New England and all over the country who may suffer from TOS. Because Mass General is a major referral center for this disorder, our program has a history of offering solutions for patients whose prior treatments were unsuccessful.

TOS symptoms may mimic those of other conditions, and patients with TOS do not always exhibit all symptoms of the disorder. As a result, diagnosing the patient's condition can be challenging and requires a careful evaluation. Our extensive experience enables us to make an accurate diagnosis and recommend the most appropriate course of treatment, which may include physical therapy and/or surgery.

Our thoracic surgeons make every effort to explore a wide range of treatment options and tailor them to individual patients. We take a multidisciplinary approach to diagnosis and treatment, collaborating with orthopedic surgeons, neurosurgeons, specialists at the Center for Pain Medicine and others at Mass General. We also work with physical therapists who are experienced in helping patients with TOS.

Research Focused on Diagnostic Techniques

Making the correct diagnosis is the key to successfully treating TOS, so our research efforts have focused on improving diagnostic techniques.

In collaboration with the Mass General Imaging Department, our researchers have developed unique protocols for MRI and CT scans in diagnosing TOS. In addition, the Mass General TOS program is part of the Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome (CORE – TOS), a nationwide effort among various hospitals to improve diagnosis and treatment. Finally, in addition to using ultrasound-guided injections to help diagnose TOS — a technique practiced at few other hospitals — our division is conducting research to improve the clinical effectiveness of this technique. We are also conducting research to continually improve the effectiveness of existing techniques.

To make an appointment, please contact the program at 617-724-0969.

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Thoracic Outlet Syndrome Program

Phone: 617-724-0969