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Thoracic Outlet Syndrome (TOS)

The thoracic outlet is located between the armpit and base of the neck. Bordering a passageway that travels through it is muscle, bone and tissue. Thoracic Outlet Syndrome (TOS) occurs when the packet of blood vessels and nerves that run through this path, from the chest to upper extremities, become pinched.

Medical director of Thoracic Surgery at AdventHealth Celebration, Farid Gharagozloo MD, FACS, has substantial experience and expertise treating TOS. He is widely recognized as one of the premiere thoracic surgeons in the country treating this disorder.

Diagnosing TOS

Patients can experience a range of symptoms. These can be from intermittent and mild—up to chronic pain in the neck, shoulder and arm. It can also include swelling, numbness and weakness in affected areas. In more serious cases, blood vessels can become very constricted and impair blood flow to the arm. This may lead to discoloration and pain extending down to the hand. If symptoms become severe, it can cause deadly blood clots.

Causes of TOS include an inherited defect that causes an abnormal first cervical rib extending from neck. However, it can also be caused by environmental factors. These include injuries, obesity, weightlifting, pregnancy and occupations that require constant arm to shoulder motion.

Whatever its cause, TOS can be very difficult to diagnose and treat. Historically, this “ghost pain” was treated using prescription medications and physical therapy. However, proper diagnosis can now be achieved through a magnetic resonance angiography (MRA) or a magnetic resonance venography (MRV). These non-invasive, painless medical tests provide clear images of blood or nerve blockage to help physicians diagnose and treat TOS.

Treating TOS

Surgical Approach

When you are experiencing chronic pain and numbness, with little or no relief through other methods, surgery may be recommended. This is particularly true if you have a malformed first cervical rib.

This surgical area is usually difficult to reach using traditional methods. That’s why the AdventHealth Global Robotics Insitute at AdventHealth Celebration offers a robotic-assisted approach. Using a minimally invasive procedure allows the surgeon to partially remove the first rib. This has been associated with a lower likelihood of neurovascular complications. Plus it can provide speedier recovery and healing, with less pain.

To learn more or to schedule a consultation with our Oncology and Thoracic Surgery Program clinical care coordinator, call (407) 303-4877.