Thoracic Outlet Syndrome (TOS) Treatment in Hyderabad

Expert Diagnosis & Advanced Vascular Care at RIVEA

Comprehensive TOS Care Led by U.S.-Trained Vascular Specialists

Dr. Karthik Mikkineni, Chief Vascular Surgeon
U.S.-trained | American Board Certified Vascular Specialist

If you're experiencing unexplained arm pain, numbness, swelling, or circulation problems, specialized evaluation can identify whether Thoracic Outlet Syndrome may be the cause and guide you toward the most effective treatment.
Early diagnosis prevents serious complications and restores quality of life.

Understanding the Condition: Symptoms, Diagnosis, and Treatment Options

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome (TOS) is a condition caused by compression of nerves or blood vessels as they pass through a narrow space between the collarbone and first rib called the thoracic outlet (also known as the thoracic inlet or superior thoracic aperture).

This passageway contains critical structures:

Brachial plexus - nerves traveling from your neck to your arm
Subclavian artery - supplies oxygen-rich blood to your arm
Subclavian vein - drains blood from your arm back to your heart

Normally, this opening is wide enough to allow nerves and blood vessels to pass through easily. However, this space can become too narrow due to anatomical variations, injuries, or repetitive movements, causing compression that leads to pain, numbness, swelling, or circulation problems in the neck, shoulder, arm, or hand.

What are the different types of Thoracic Outlet Syndrome (TOS)?

There are three main types, classified by what's being compressed:

Neurogenic TOS (most common - about 95% of cases)

Affects the brachial plexus nerves
Most people receive a diagnosis in their 30s
Most common causes are repetitive stress injuries (often from sports) and sudden trauma to the neck (like whiplash)

Venous TOS

Affects the subclavian vein
More common among males, typically in their 20s or 30s
Usually affects the dominant arm
Often requires surgical treatment

Arterial TOS (least common - about 1% of cases)

Affects the subclavian artery
Among people younger than 40, arterial TOS is the most common cause of acute blood clots in the arm
Usually happens due to anatomical differences you're born with (like a cervical rib—an extra rib near your first rib)
More common among females (up to 70% of cervical ribs occur in females)
Typically requires surgical treatment

Common symptoms

Symptoms vary and depend on the type of TOS you have. Symptoms typically affect one side of your upper body and may include:

Neurogenic TOS:

Pain in neck, shoulder, or arm

Tingling or "pins and needles" sensation

Numbness in fingers or hand

Weakness or muscle wasting

Symptoms worsen when raising your arm

Venous TOS:

Arm swelling or heaviness

Bluish or pale skin discoloration

Visible veins on chest or shoulder

Arm pain or aching

Arterial TOS:

Cold fingers or hand

Pale or bluish fingertips

Weak or absent pulse in arm

Arm pain during activity

Slow-healing sores on fingers

Possible blood clots

Will Thoracic Outlet Syndrome (TOS) get worse if left untreated?

In some people, symptoms remain mild and intermittent. In others, compression can worsen over time, leading to serious complications including:

Reduced blood flow
Permanent nerve damage
Gangrene
Open sores (ischemic ulcers) on fingers
Pulmonary embolism
Chronic arm swelling and pain, especially in venous TOS

Early evaluation helps prevent long-term complications and improves treatment outcomes.

What causes Thoracic Outlet Syndrome?

Healthcare providers divide causes into three main groups:
Congenital (variations you're born with):

Cervical rib (extra rib)
Abnormalities in ribs, neck muscles, or nearby ligaments
These variations may put pressure on nerves or blood vessels

Traumatic (sudden injuries):

Car accidents (whiplash)
Injuries to the neck or shoulder
Trauma to the neck and upper chest area

Functional (repetitive actions):

Vigorous arm movements in sports (baseball, swimming, golf, volleyball)
Repetitive overhead lifting
Weightlifting
Carrying heavy shoulder loads
Actions that repeatedly irritate or injure structures in the thoracic outlet

Note: Congenital factors may predispose some people to TOS, but symptoms may not appear until there's trauma from a sudden injury or chronic overuse.

How is Thoracic Outlet Syndrome diagnosed?

Diagnosis involves a combination of:

Detailed clinical examination and medical history review
Symptom-provocation tests and movement-based tests
Imaging to assess nerve and blood vessel compression

Your provider may perform specific tests during the physical exam, including:

Upper limb tension test
Elevated arm stress test

For these tests, you'll perform simple movements like lifting your arms, tilting your head, and clenching your fists. Your provider will see which movements trigger pain or other symptoms to help with diagnosis.

What tests are commonly used?

Depending on symptoms, tests may include:
Imaging:

Chest X-ray (to look for anatomical variants like a cervical rib)
Ultrasound to assess blood flow
CT or MR angiography to visualize arteries and veins
MRI of the chest and/or spine to assess soft tissue and nerve involvement

Functional tests:

Nerve conduction studies
Electromyography (EMG) to check muscle and nerve function
Blood tests as needed

These tests help your provider:

Look for anatomical variants
Evaluate blood flow through arteries and veins
Rule out other conditions that cause similar symptoms
Check the function of muscles and nerves
Find the exact location of compression

Treatment Options & Comparison

What are the non-surgical treatment options?

Many patients benefit from:

Physical therapy - the most common initial treatment for neurogenic TOS, helping increase range of motion in neck and shoulders, strengthen muscles, and promote better posture
Postural correction and exercises to improve posture
Pain management (over-the-counter pain relievers such as NSAIDs)
Activity modification
Medications to relieve pain

Most people with neurogenic TOS see an improvement in symptoms with conservative treatment.

What are the surgical procedures for TOS?
Depending on the type of TOS, treatment may include:

Anticoagulant medication - to prevent blood clots
Endovascular procedures - for clots or vein narrowing
Decompression surgery - removes abnormal bone or tissue causing compression
Vascular repair surgery - repairs structural problems with blood vessels to improve blood flow
Combined approaches in selected cases
Thrombolytic therapy - medication through an IV line or catheter that dissolves existing blood clots and prevents new ones (for arterial or venous TOS)

Surgeons use different methods depending on the type of TOS and your anatomy. Your provider will explain what your specific procedure involves and any possible risks.

When is surgery or intervention recommended?
Procedures may be advised for:

Arterial or venous TOS (most people with these types need surgery)
Recurrent blood clots
Persistent nerve compression despite therapy
Failed conservative treatments
Evidence of significant vascular complications

Why TOS Requires Expert Evaluation

TOS is frequently misdiagnosed because symptoms can mimic:

Cervical spine problems
Rotator cuff injuries
Carpal tunnel syndrome
Heart problems (angina)
Other nerve or circulation disorders

Accurate diagnosis requires:

Experienced vascular specialist evaluation
Comprehensive physical examination
Advanced imaging (ultrasound, CT/MR angiography, MRI)
Correlation of symptoms with clinical findings

Why Choose RIVEA for Thoracic Outlet Syndrome?

Evidence-Based, Patient-Centered Vascular Care
At RIVEA Vascular Institute, we understand that accurate diagnosis is the foundation of effective TOS treatment. Our comprehensive approach combines clinical expertise, advanced technology, and personalized care.

RIVEA is co-founded and led by Dr. Karthik Mikkineni, U.S.-trained Chief Vascular Specialist, whose advanced expertise in complex vascular conditions strengthens RIVEA's position as a centre of excellence for comprehensive vascular care. The vascular department is also supported by Dr. Syed Mohammed Ali Ahmed, who brings extensive experience in both open and endovascular vascular surgery.

What Sets RIVEA Apart for Thoracic Outlet Syndrome Treatment:

Expert diagnosis and management of all three types of TOS (neurogenic, venous, and arterial)
High-resolution imaging (ultrasound, CT angiography, MR angiography) for precise diagnosis
Full spectrum of care from conservative management to surgical intervention
Expertise in both open and endovascular techniques ensures the right treatment approach
Endovascular-first approach when appropriate for faster recovery and shorter hospital stays

Our Capabilities:

Endovascular interventions - catheter-based clot removal and vein treatment
Thrombolytic therapy - advanced clot-dissolving treatments
Surgical decompression - removal of compressive structures (ribs, muscles, scar tissue)
Vascular reconstruction - repair of damaged arteries or veins
Minimally invasive techniques - when appropriate for faster recovery

If you experience unexplained arm pain, numbness, swelling, or circulation issues, a specialist evaluation can help identify whether Thoracic Outlet Syndrome may be the cause.

Thoracic Outlet Syndrome may be challenging to diagnose, but expert evaluation and timely treatment can prevent serious complications and restore your quality of life.

Early diagnosis leads to safer, more effective treatment and better long-term outcomes.

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FAQs

How do I know if my arm pain is Thoracic Outlet Syndrome (TOS) or something else?

TOS symptoms often overlap with neck problems, carpal tunnel, shoulder injuries, or even heart issues. A proper diagnosis requires evaluation by a vascular specialist who can examine you, order targeted imaging, and rule out other causes. Persistent arm pain, numbness, or swelling should not be ignored.

Can TOS cause chest pain? How is it different from heart pain?

Yes. TOS can cause pain near the collarbone or upper chest, often worsening when the arm is raised. Heart-related chest pain is usually linked with exertion and may include breathlessness, sweating, or nausea. Any sudden or severe chest pain needs emergency care.

Why is TOS so often missed or misdiagnosed?

Because symptoms mimic many common conditions and basic tests can appear normal. TOS requires specialized knowledge and testing. If you’ve had unexplained upper-body symptoms for months, a vascular specialist evaluation is important.

Do TOS symptoms start suddenly or develop over time?

Both occur.

Gradual onset: Common in neurogenic TOS due to posture or repetitive activity
Sudden onset: Seen in venous or arterial TOS, sometimes after injury or intense activity

Can TOS affect both arms?

It usually affects one arm (often the dominant side), but both arms can be involved, especially in people with anatomical variations or repetitive bilateral activity.

Is physical therapy effective? How long should I try it?

For neurogenic TOS, 3–6 months of supervised, targeted physical therapy is usually recommended before considering surgery. Vascular TOS often requires surgery regardless of therapy response.

When is surgery needed, and how safe is it?

Surgery is considered when symptoms persist or vessels are involved. When performed by experienced vascular surgeons, TOS surgery is generally safe, with serious complications being rare. Most patients experience significant improvement.

What is recovery like after TOS treatment or surgery?

Non-surgical care: Gradual improvement over weeks to months
After surgery: Most return to desk work in 2–4 weeks; full recovery takes 3–6 months with rehabilitation

Pain usually improves steadily with time and therapy.

Can TOS come back after treatment?

Recurrence is uncommon when treatment is complete and posture, ergonomics, and activity modifications are maintained. If symptoms return, they are often milder and may respond to therapy.

Why is early diagnosis and treatment so important?

Early care leads to better outcomes, safer treatment, and prevents complications such as permanent nerve damage or blood clots. Prompt evaluation makes a meaningful difference.

Can TOS go away on its own?

Don't wait for symptoms to go away. Seek medical care if you have symptoms of TOS. While conservative measures like physical therapy alleviate symptoms in many cases, some people need surgery or other treatments to prevent serious complications.

Thoracic Outlet Syndrome (TOS) Treatment in Hyderabad