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Presbyterian/St. Luke’s Medical Center

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Center for Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is pain, numbness, tingling, and/or weakness in the arm and hand due to pressure against the nerves or blood vessels that supply the arm. It is due to tight muscles, ligaments, bands, or bony abnormalities in the thoracic outlet area of the body, which lies just behind the collar bone. Pressure on the nerves is the problem more than 90% of the time, but occasionally the artery or vein is involved.

Presbyterian/St. Luke’s Medical Center is fortunate to have two outstanding board certified vascular surgeons involved in the evaluation and treatment of Thoracic Outlet Syndrome.  Dr. Richard Sanders is a pioneer in TOS and author of the book, Thoracic Outlet Syndrome:  A Common Sequela of Neck Injuries, as well as many articles advancing the field for more than 20 years.  Dr. Steve Annest is a national lecturer on that TOS and has participated in an innovative and promising approach to treat patients with recurrent brachial plexus problems after thoracic outlet surgery. He treats patients from across the country suffering from Thoracic Outlet Syndrome.

Common Symptoms

The most frequent complaints are numbness and tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand; worsening of the symptoms when elevating the arm to do such things as comb or blow dry one's hair or drive a car; and coldness and color changes in the hand. The symptoms are often worse at night or when using the arm for work or other activities.


Thoracic Outlet Syndrome can be caused by the following:

  • Whiplash injuries from auto accidents
  • Repetitive stress in the workplace
  • An extra rib in the neck occurs in less than 1% of the population.