What is Thoracic Outlet Syndrome, How is it Diagnosed and Treated

Assistant Professor of Surgery Dr. Ying Wei Lum discusses causes, symptoms and risk factors of thoracic outlet syndrome.

Questions answered:
1. Describe what you do. (0:11)
2. What is thoracic outlet syndrome? (0:42)
3. How is thoracic outlet syndrome diagnosed? (1:07)
4. What kind of lab should conduct testing and scans? (2:01)
5. What are the treatment options for thoracic outlet syndrome?(2:48)
6. Briefly describe the procedure. (3:29)
7. What is the recovery like post surgery. (3:48)
8. What can patients expect after treatment? (4:10)
9. Is this likely to recur? (4:35)
10. What is the most rewarding thing that you do? (4:57)
11. Why come to Johns Hopkins for treatment of thoracic outlet syndrome? (5:30)

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Comment (93)

  1. Can you please discuss specific tests you do at Johns Hopkins Hospital to Diagnose Neurogenic Thoracic Outlet Syndrome?  (You speak about vascular compression but not about specific tests for neurogenic T.O.S.)  Can you also PLEASE give the percent of cases that need a re-operations??, statistics on how much scar tissue after surgery over the nerves and structures CAN cause MORE problems than prior to surgery.  Can you please tell us exactly the percentage of LONG TERM successful TOS surgeries you have done?  Can you define Success after neurogenic TOS surgery?  Can you please tell how many patients get TOS in their OTHER arm after neurogenic TOS surgery.  Can you please tell us the success rate on patients in middle age? Can you please tell us how long you follow your post TOS patients and how this surgery affects their lives?  Can you please give a percentage on Phrenic Nerve Paralysis with your TOS surgery–and do you always remove the 1st rib? If not, or if so–WHY??  Thank you–I'll await your answers!!

  2. So some cases of TOS are not compressing arteries, right, doc? I'm worried about mine,  but I"m glad I just figured out (presumtive diagnosis on my part) what has been causing my pain is Thoracic Outlet Syndrome. My right shoulder has always been crippled looking and 'lower'.. i've played piano and hunched over computers most of my 26 years of life so far. Theres a burning to sometimes sharp pain in the areas typically outlined on images showing the pain area.. the inner lower arm and out part of the hand and fingers up to the middle finger, it's like a muscle tightness or nerve pain that I can't twist myself out of. My neck itself deviates to the right (same side) which is interesting.. I suspect the neck stabilizing muscles are not working right due to nerve compresssion.. so that' my main question – could it be that it's just affecting nerves and not vessels/arteries? I'd hate to think this puts me at risk for heart attack or stroke. I'll go over my primary with this stuff, but I'd appreciate any feedback you may have based on my description.

  3. My son was treated with thrombolytics followed by a rib resection surgery last week for TOC. I am extremely pleased with his surgeon who trained at Johns Hopkins. He has now been on Lovenox injections twice daily for several weeks, as prior to the correct diagnosis of TOC the Docs were treating him with the assumption that he had an inherited clotting disorder. He is recovering extremely well from the surgery, but the twice daily injections are really starting to wear on him (he is 17). Your video is a very good, streamlined presentation of the issue, its diagnosis and treatment. You don't talk about your use of anti-coagulants as part of the post surgical recovery for patients following rib resection surgery. I am curious what your protocol for this is.

  4. Dear JHM, near 3:01 when talking about "compression of the nerves" it sounds like and closed caption reads that it can be "killer to the patient." Is that the intended statement? What is meant by that?

  5. Hi I been diagnosed with TOS by a vascular surgeon recently. I have arm pain and also pain in my Thai and also looks like my right side of my face is drooping compared to my left side. The Dr. has schedule a CT scan on June. I wanted to get one more opinion. Can someone give me some advice on this issue.

  6. I've recently found out that I have this syndrome. when I was 16 I got diagnosed with hearing loss due to TOS, and I'm now 17. I went to another hearing test and my audiologist said she wants me to go to a lot of follow ups with specialist, because it's so rare that it affects the bones in my ears. Is there an way to help fix my hearing loss? the pain and tingling in my arm is something I've learned to deal with, but I'm really worried that my hearing my get worse, as well is my audiologist.

  7. Does anyone feel alone in having tos? I've been going from doctor to doctor trying to find out what is wrong w me. And the pain is excruciating at times. I've starting getting a lot of pain in my right thumb area. I was just diagnosed last week after 9 months of chiropractic work, therapy and a few docs! The doc said he wished I wasn't giving pain meds for this! Wth! Am I supposed to live w the pain? He was not very caring. Is sending me to therapy for 8 wks & if that doesn't work then he said he'll give me nerve meds! I hope therapy works! Does anyone else have these problems and anyone have any advice for me???

  8. I have a decent sized knot in subclavin vein area on right side of my body and that arm gets tired easily. I cleaned horse for years I think that’s what caused it. I need to get it checked out

  9. Mine is neurogenic status post rotator cuff repair, at 14 months still unable to use my dominant hand for more than 10 minutes and that's with pain of 6 and 7, hand just stops working after that, no fine motor ability or strength. Unable to use for the cold, pins, needles and numbness. Frustrating is it's from a work injury. Praying my smart doctor can help me further instead of putting me out to pasture. Moo? 😭😜😒

  10. Can you have a dissection of the artery in the innominate artery caused by TOS? They have found I have vascular TOS but I also have had extreme pain in my central and right chest and cannot walk anywhere.

  11. This is an interesting view of thoracic outlet syndrome. However, what is missing is that muscle contractions or splinting spasms lift the rib up into the outlet and pull the shoulder down into the outlet. The proof this is the cause is that the surgeon removes the scalene muscles and the rib these muscles lift into the outlet. What is not mentioned is that the shoulder is also dragged into the thoracic outlet causing pressure on the nerves artery and vein and tat too is caused by contraction of the pectoralis minor, The surgical treatment is to surgically remove or cut the muscle. So if you have a spasmed, contracted muscle in your neck and shoulder do you cut it out or relax the muscle?

  12. I want/need this surgery. I’ve had this agonizing pain for 12 years now. I can’t do normal faulty activities or sleep. I use to be so active and now i look forward to laying down with my heating pad. It’s ridiculous. I wish drs listened to me when i first got injured 🤕 12 years is too long and I’ve always asked/begged in tears if they could just cut it the fuck out of me and they always said “your arm would droop”
    And my response is always “but will I have pain” 🤷🏼‍♀️🤔

  13. I was just diagnosed with this after 5 years and 16 specialists at vamc and Cleveland clinic.
    5 years of torturing pain that destroyed my life but it ain't over yet.

  14. My doctor read my x-ray and new what I had but never wanted to tell me so I didn't know, years later I found out it was TOS.

    Can you die from TOS due to not getting blood supply. I already have problems with my heart, I was told I'm not getting enough blood supply, than I get a heart attack. TOS is very serious and extremely painful, I can't move at all, I don't understand how people say you can do exercise when you can't move. TOS pain would travel to my back neck to the upper head giving me a headache, spine, shoulder, arm, and sometimes dizziness.

  15. Fresh diagnosis of TOS and due to age and changes of activity suspect probably posture related. Trying exercises and discipline in posture before further analysis. Right now if I were cuffed hands behind my back I would be in excruciating pain for the duration.

  16. I was told that nearly 80% of NTOS patients can get well with PT and medication but here in youtube seems TP is not effective and no one got better with PT and surgary is end of the road and pain. Im just hopeless

  17. After 2 years of pain, I was recently diagnosed with TOS. I lose sleep due to the numbing, tingling, and pain in my neck, shoulder, arm extending down to my fingers. I wake in the morning with, literally, a dead arm….all feeling and sensation in my hand is gone, and I can't move it on it's own. Takes me a few hours to get it back to some bit of feeling. A painful and horrible thing, but happy to find these videos and know that I am on my way to managing it.

  18. i was diagnosed with an extra cervical rib (left side) with the possibility of TOS i have been experiencing chest pain frequently, soreness under my left armpit an sometimes weakness in my left arm i went to a cardiologist for my chest pain an they did an ekg an came back good….so i’m just wondering is it possible for TOS to cause chest pain? Please respond with this epidemic going on in america it’s impossible to get responses, Thanks


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