Thoracic Outlet And Cervical Rib

Thoracic Outlet Syndrome (TOS) is a condition that happens when blood vessels or nerves are squeezed in a small space near the lower neck and upper chest—called the thoracic outlet. This space lies between the collarbone and the first rib. When something in this space presses on the arteries or veins, it can lead to a type of TOS known as arterial or venous TOS.

Post excision of cervical rib
curve

One of the common causes of this problem is something called a cervical rib – an extra rib that some people are born with. Not everyone with a cervical rib has symptoms, but in some people, it can press on nearby blood vessels and cause serious issues.

Intraoperative photo of rib compressing the artery

What is Arterial Thoracic Outlet Syndrome?

In arterial TOS, the artery that carries blood to your arm (called the subclavian artery) gets compressed. Over time, this pressure can damage the artery wall, narrow the blood flow, and even cause clots or small aneurysms (ballooning of the artery).

Common symptoms include:

  • A cold or pale hand
  • Weak pulse in the wrist
  • Pain or cramping in the arm when using it
  • Numbness or tingling in the fingers
  • Sometimes, small ulcers or dark spots on the fingertips

These symptoms happen because the arm isn’t getting enough oxygen-rich blood.

What is Venous Thoracic Outlet Syndrome?

In venous TOS, the large vein that carries blood from the arm back to the heart (called the subclavian vein) gets compressed. This can lead to swelling and even blood clots.

Symptoms of venous TOS may include:

  • Sudden swelling of the arm or hand
  • A feeling of heaviness or tightness
  • A bluish or dark color to the skin
  • Bulging veins around the shoulder or chest

This type often occurs in young, healthy people after heavy lifting or repetitive arm movements, like gym workouts or sports. A clot in this vein is sometimes called effort thrombosis or Paget-Schroetter syndrome.

What is a Cervical Rib?

A cervical rib is an extra rib that forms above the first rib. Not everyone has it – it’s a rare condition. In some people, this extra bone or its attached tissue presses on the artery or vein in the thoracic outlet and causes symptoms. Sometimes, even without a full rib, a thickened band of tissue can cause similar problems.

How Is It Diagnosed?

Your doctor may suspect TOS based on your symptoms and physical exam. Tests such as ultrasound, CT angiography, MRI, or venography may be done to look at the blood flow in your arm and detect any blockages, clots, or compression.

Treatment Options

Treatment depends on the type of TOS:

  • Venous TOS often needs blood thinners and sometimes a procedure to remove a clot, followed by surgery to remove the compression – usually by removing the first rib (or cervical rib).
  • Arterial TOS usually needs surgery to repair the artery and remove the rib or other tissue causing the pressure.
  • Recovery is generally good with early treatment and proper follow-up.
Right subclavian artery compressed between clavicle and cervical rib

If you have arm pain, swelling, color changes, or feel something just isn’t right – especially after exercise – don’t ignore it. Talk to a vascular surgeon and get the right evaluation. TOS is treatable, especially when caught early.

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Let Us Help You Walk Again

At our clinic, We offer the latest therapies, honest guidance, and personalized care. If you or your loved one is living with Thoracic Outlet And Cervical Rib, don’t delay. Book an appointment and let’s plan the best way forward — together