Austen 7
55 Fruit Street
Boston,
MA
02114
Phone: 617-726-5200
Fax: 617-726-7667
The Thoracic Outlet Syndrome Program at Massachusetts General Hospital specializes in expert evaluation and treatments for a wide range of thoracic outlet syndrome (TOS) cases, both common and complex.
Our pioneering work in thoracic outlet syndrome has established Mass General as a major referral center for this complex condition, helping patients across the United States and around the world. With a rich history of success, our care team excels in offering solutions for patients with symptoms of TOS, including those whose prior treatments were unsuccessful. We care for people of all ages, including children, young adults, adults, and older patients.
The thoracic outlet is a narrow space in the body located behind the collarbone and in front of the first rib. Thoracic outlet syndrome is a group of disorders that occur when the brachial plexus nerves, subclavian vein, and/or subclavian artery are irritated or damaged due to compression (squeezing) in this area.
Symptoms can include, but are not limited to, shoulder, neck, arm, hand and finger pain, numbness, discoloration, and swelling.
The three types of TOS that affect the thoracic outlet are:
Our team effectively treats people of all ages by giving them personalized and age-appropriate diagnoses and treatment plans. Many of our patients are high school and college athletes, as well as professional athletes. We work closely with our patients to achieve their goals of returning to sports and work and improving their quality of life.
Our minimally invasive diagnostic tests and treatments often provide alternatives care options to surgery. When surgery is recommended, we provide the necessary information for patients to make informed decisions about their health care. Our expert team is available to answer any questions.
Correctly diagnosing thoracic outlet syndrome is the key to successfully treating it. We customize a diagnostic and treatment plan for each patient.
Our thorough clinical assessment begins at the initial office visit with a detailed physical examination and discussion about their medical history. Examinations and treatments are tailored to each patient’s needs and may include:
Our CT angiogram and ultrasound-guided muscle injections using botulinum toxin A are scheduled once your physician has ordered them. They may require prior authorization from your insurance. During this process, we may need to communicate with you.
About the CT Scan
This is a specially configured CT scan created by radiology experts at Mass General. It provides a detailed view of the thoracic outlet area from the top of the neck to the middle of the chest. It can take up to five days to develop and recreate these images in 3-D. Once the radiologist has interpreted the scan results, you will be contacted by our office to discuss them.
About the Ultrasound-guided Muscle Injections
Sometimes, the neck and shoulder muscles compress and irritate the nerves and blood vessels in the thoracic outlet. One way our team checks for and treats thoracic outlet syndrome is by injecting botulinum toxin A into these muscles. These injections are done by radiologists using ultrasound imaging to precisely target specific muscles. The injections may help relieve some of the compression in the thoracic outlet and improve symptoms. We use a symptom tracker to determine improvements.
Your care team will work with you to decide the best next steps in your care plan.
Treatment for Neurogenic TOS
Ultrasound-guided injections with botulinum toxin A may help relieve nerve compression for patients with neurogenic thoracic outlet syndrome. Many patients whose symptoms have improved following muscle injections may be able to participate more actively in physical therapy, which can improve the overall results. If symptoms do not improve, surgery will be discussed.
Treatment for Venous TOS
Doctors can find venous TOS in two ways: a duplex ultrasound of the upper body, like the arm or shoulder, or with a test called an arteriogram or venogram. Both of these tests help doctors see if there is a clot in the blood vessels.
When a clot is found, medication is used to dissolve it. However, for most patients, just treating the clot is not always enough. The main problem is often the veins that were narrowed by the compression in the thoracic outlet region. If there is pressure on the vein from the outside, surgery from a highly trained TOS specialist may be recommended to fix it. Patients may need to continue to use blood-thinning medication to prevent blood clotting for up to three months following surgery.
Treatment for Arterial TOS
Arterial thoracic outlet syndrome, which is the rarest type of TOS, occurs when pressure harms the blood vessel. Just because there's pressure doesn't mean the blood vessel is damaged, so doctors use special imaging with contrast to carefully check for damage, such as a duplex ultrasound of the upper body.
Patients with arterial TOS often require surgery. They will meet with a highly trained TOS specialist to discuss their options.
Surgery to Treat TOS
When non-surgical treatment does not correct the compression (pressure) or clotting in the thoracic outlet area of the body, surgery can relieve the pressure by creating additional space and repairing damaged arteries and veins. Patients who require surgery can be confident that they will receive specialized care from an experienced team. A successful surgical outcome depends on an accurate diagnosis and expert-level surgical care. Your care team will work with you to decide if surgery is a good option for you.
Surgery for thoracic outlet syndrome may include:
Thoracic outlet syndrome—neurogenic, venous, and arterial—can affect children. Our team has significant experience in caring for patients of all ages, including those whose prior TOS treatments were unsuccessful. For pediatric patients with TOS, we most commonly see adolescents between the ages of 10-18, typically with neurogenic TOS or venous TOS. Though not technically considered pediatric, our team is also experienced in treating young adults with TOS between the ages of 19-25.
The symptoms of TOS in children are often the same as adults, such as:
Parents and caregivers are an important part of the child’s care team and will be involved every step of the way.
In the initial appointment, your child will undergo an age-appropriate evaluation, which will include a physical exam and a conversation about their medical history. Every effort is made to diagnose and treat this syndrome minimally invasively. Tests and treatments will be thoroughly explained, and questions are encouraged. Our care team will follow your child’s progress throughout this process. Younger patients occasionally require anesthesia when receiving tests to diagnose their condition.
Children diagnosed with TOS may need to take a break from activities that may aggravate their symptoms, such as sports. It is always our goal to provide your child with everything they need to recover and get back to what they love to do. Your care team will support you and your child through the treatment journey.
A combination of physical therapy and minimally invasive ultrasound-guided injections may be recommended. Your child will be provided with ongoing support from the entire care team. If surgery is recommended, your child may have to stay at the hospital to recover after surgery. Specialized care is provided within the hospital.
Enroll your child in Patient Gateway
Kerri and three of her children—her son Michael and twin daughters Ashtyn and Brett—have been gradually diagnosed with the disorder over the past decade and treated at Mass General. Kerri describes the family’s journey with this elusive disorder and the steps they took to pursue the best possible treatment.We are dedicated to making sure that patients with TOS understand their options and have all the information they need to feel confident in their health care decisions.
If you have worker's compensation insurance, please inform our staff immediately.
The Mass General billing department will then contact your adjuster to agree on payment for this visit. Please inform our staff if the adjuster requires a request from our office. Once this information is processed, you will be scheduled for a new patient appointment.
Mass General accepts most health insurance plans, including Medicare and Medicaid.
Before scheduling your first visit, check with your health insurance provider to learn about your coverage. Mass General cannot guarantee that your insurance provider will pay for your care. It is your responsibility to understand what types of coverage your health insurance provides and to be sure that you meet all requirements set by your specific plan.
Your health insurance provider will be able to inform you of your level of coverage and what, if any, copayments, coinsurances and deductibles will be your responsibility. If you do not contact your provider, you can ultimately be responsible for all or a large portion of your bill.
Learn more about billing and insurance at Mass General
The key to treating thoracic outlet syndrome is correctly diagnosing it. Our research focuses on improving diagnostic techniques. In collaboration with the Mass General Department of Radiology, our researchers developed unique ways for using MRI and CT scans to diagnose TOS, including two new evaluation strategies. We adjusted each technology to develop images that are more detailed than what was previously available, providing a more accurate diagnosis of thoracic outlet syndrome.
View recently published research
Our doctors are highly skilled in properly diagnosing and treating thoracic outlet syndrome.
Kerri Smart and three of her children were gradually diagnosed with thoracic outlet syndrome over a decade and treated at Massachusetts General Hospital. Kerri describes the family’s journey with this elusive disorder and the steps they took to pursue the best possible treatment for TOS.
If you would like to request an appointment with or refer a patient to the Thoracic Outlet Syndrome Program, please use the following contact information.
