What is Thoracic Outlet Syndrome, How is it Diagnosed and Treated

Assistant Professor of Surgery Dr. Ying Wei Lum discusses causes, symptoms and risk factors of thoracic outlet syndrome.
Questions answered:
1. Describe what you do. (0:11)
2. What is thoracic outlet syndrome? (0:42)
3. How is thoracic outlet syndrome diagnosed? (1:07)
4. What kind of lab should conduct testing and scans? (2:01)
5. What are the treatment options for thoracic outlet syndrome?(2:48)
6. Briefly describe the procedure. (3:29)
7. What is the recovery like post surgery. (3:48)
8. What can patients expect after treatment? (4:10)
9. Is this likely to recur? (4:35)
10. What is the most rewarding thing that you do? (4:57)
11. Why come to Johns Hopkins for treatment of thoracic outlet syndrome? (5:30)

[@Ducky2964]

I’m beyond proud to say this is my surgeon. He’s awesome!

[@Brklyn_NuYawka]

After 2 years of pain, I was recently diagnosed with TOS. I lose sleep due to the numbing, tingling, and pain in my neck, shoulder, arm extending down to my fingers. I wake in the morning with, literally, a dead arm....all feeling and sensation in my hand is gone, and I can't move it on it's own. Takes me a few hours to get it back to some bit of feeling. A painful and horrible thing, but happy to find these videos and know that I am on my way to managing it.

[@maziepaine1443]

Same! It sucks! I’m only 10 though

[@TheSierraRaquel]

SAME! It’s very scary!

[@maggot1917]

This has been happening to me since I was a teenager.. I'm 29 now. I think it's caused mainly by sleeping. I thought I had carpal tunnel (I'm diagnosed with it) but I think I have TOS

[@immie52]

Omg i have the same feeling they did mri and Emg test without results, with mri again for my schouder and nek they think i have inpigment syndrome thats not true becus i have tintling and num feeling in my arm sometimes i cant use my fingers letting things fall from my hand. They cant diagnose it very good ☹

[@jacobkaneff8261]

76k views. It's a sign.

[@GoogleMe_]

Trust the Process

[@pointchamberlain4782]

@@GoogleMe_ wilts the goat

[@lizsimpson3]

My son was treated with thrombolytics followed by a rib resection surgery last week for TOC. I am extremely pleased with his surgeon who trained at Johns Hopkins. He has now been on Lovenox injections twice daily for several weeks, as prior to the correct diagnosis of TOC the Docs were treating him with the assumption that he had an inherited clotting disorder. He is recovering extremely well from the surgery, but the twice daily injections are really starting to wear on him (he is 17). Your video is a very good, streamlined presentation of the issue, its diagnosis and treatment. You don't talk about your use of anti-coagulants as part of the post surgical recovery for patients following rib resection surgery. I am curious what your protocol for this is.

[@cardicon23]

I came here for the same reason why you’re here. 🏀 🏀

[@chirayudesai793]

Markeeeeellleee

[@BrockMak]

Elton Brand, same difference, as he was talking about Fultz.

[@JorgeandHisVideos]

Life balling me up

[@laurenrivera8809]

I want/need this surgery. I’ve had this agonizing pain for 12 years now. I can’t do normal faulty activities or sleep. I use to be so active and now i look forward to laying down with my heating pad. It’s ridiculous. I wish drs listened to me when i first got injured 🤕 12 years is too long and I’ve always asked/begged in tears if they could just cut it the fuck out of me and they always said “your arm would droop” And my response is always “but will I have pain” 🤷🏼‍♀️🤔

[@trlprktim]

I was just diagnosed with this after 5 years and 16 specialists at vamc and Cleveland clinic. 5 years of torturing pain that destroyed my life but it ain't over yet.

[@travismcdonald4644]

@D. R. How is life post surgery?

[@MacchiatoSwirlGirl]

Holy crap I have stenosis as well after a cervical fusion my rib cage popped out and my shoulder has an impingement my bicep is torn and my wrist are so dam painful it's excruciating

[@captainbuggernut9565]

This is the best information ive come across to date. I have suspected TOS. It started with chest pain has become pain in my shoulder and down my outer arm as a burning sensation with pins and needles with numbness in certain positions in my left hand. I also have a persistent lightheaded feeling. This last one I would dearly love to know if its connected to TOS. Its taken 2 years to get this far. I've had xrays, blood tests and an mri on my neck, brain and spine. I've also developed tinnitus with the lightheaded feeling. I'm in the UK and have been referred to a vascular surgeon but my gp said he doesn't know if they do upper body ultrasound? Any ideas or suggestions for a desperate patient?

[@jcso119]

Excellent and informative video

[@drphilPCT2008]

I like this guy... too bad not all doctors were as clear and articulate. Thanks Doc... Great video explanation of TOS.... :)

[@julialawther7198]

This is my doctor and he is just as amazing as he seems

[@celam1095]

My cousin just got diagnosed with this, that's why I'm here. He's been suffering for 4 years now and no one knew what was going on with him smh

[@JohnsHopkinsMedicine]

Hi, we are sorry to hear about your cousin. If you would like to request an appointment at one of our hospitals, please call 888-872-1408. Our specially trained medical concierges can arrange consultations or treatment plans with the most appropriate specialists. Johns Hopkins USA can also provide language interpretation, financial counseling, assistance with travel arrangements and anything else to help make Johns Hopkins feel as close to home as possible.

[@guykrubpom]

clear explanation :)

[@JudgeBob]

Fresh diagnosis of TOS and due to age and changes of activity suspect probably posture related. Trying exercises and discipline in posture before further analysis. Right now if I were cuffed hands behind my back I would be in excruciating pain for the duration.

[@lynn2212]

I have cervical and thoracic spinal stenosis on the left. With any movement of my left arm or leaning over I get severe pain and intense pressure under my clavicle and down my arm. I also have weakness and fatigue in the arm. If there is vascular compression , can nitroglycerin relieve the pain?

[@moonflower7616]

Can you have a dissection of the artery in the innominate artery caused by TOS? They have found I have vascular TOS but I also have had extreme pain in my central and right chest and cannot walk anywhere.

[@gigogigo8406]

What happen to the dissection???

[@aWhiskeyTangoFoxtrot]

What is the approximate cost for surgery?

[@merynco]

Mine is neurogenic status post rotator cuff repair, at 14 months still unable to use my dominant hand for more than 10 minutes and that's with pain of 6 and 7, hand just stops working after that, no fine motor ability or strength. Unable to use for the cold, pins, needles and numbness. Frustrating is it's from a work injury. Praying my smart doctor can help me further instead of putting me out to pasture. Moo? 😭😜😒

[@SonomaGuy93]

Can you please discuss specific tests you do at Johns Hopkins Hospital to Diagnose Neurogenic Thoracic Outlet Syndrome? (You speak about vascular compression but not about specific tests for neurogenic T.O.S.) Can you also PLEASE give the percent of cases that need a re-operations??, statistics on how much scar tissue after surgery over the nerves and structures CAN cause MORE problems than prior to surgery. Can you please tell us exactly the percentage of LONG TERM successful TOS surgeries you have done? Can you define Success after neurogenic TOS surgery? Can you please tell how many patients get TOS in their OTHER arm after neurogenic TOS surgery. Can you please tell us the success rate on patients in middle age? Can you please tell us how long you follow your post TOS patients and how this surgery affects their lives? Can you please give a percentage on Phrenic Nerve Paralysis with your TOS surgery--and do you always remove the 1st rib? If not, or if so--WHY?? Thank you--I'll await your answers!!

[@MacchiatoSwirlGirl]

Very good questions

[@moxmox1]

Dear JHM, near 3:01 when talking about "compression of the nerves" it sounds like and closed caption reads that it can be "killer to the patient." Is that the intended statement? What is meant by that?

[@sfleming9046]

"....the treatment can be tailored to the patient..."

[@Ducky2964]

moxmox1 he says “tailored to the patient” he is an awesome doc. He did my 2nd surgery for TOS.

[@jclingad9589]

Fultz should get this doctor.

[@jamesweb1799]

i've 2 pairs of cervical ribs.each one starting from vertebra and attached to sternum.😭

[@marypoore9609]

Does anyone feel alone in having tos? I've been going from doctor to doctor trying to find out what is wrong w me. And the pain is excruciating at times. I've starting getting a lot of pain in my right thumb area. I was just diagnosed last week after 9 months of chiropractic work, therapy and a few docs! The doc said he wished I wasn't giving pain meds for this! Wth! Am I supposed to live w the pain? He was not very caring. Is sending me to therapy for 8 wks & if that doesn't work then he said he'll give me nerve meds! I hope therapy works! Does anyone else have these problems and anyone have any advice for me???

[@belongz2god275]

Mary Poore I am so feeling this, to the point of desperation...My word...this is unbelievable I Would love to find someone with something of what I have....I was actually BORN with Thoracic Outlet Syndrome.....BILATERAL...though it is extremely rare to have been born with this on one side it’s the more rare for it to be BOTH SIDES... as I was... as the textbooks states it, I was a twin and the other was not develop so they say you can acquire it in these situations and I did, I had extra cervical ribs on both sides and my nerves had been suppressed and damaged since birth....I cannot seem to get any help whatsoever... I had the surgeries years ago, first the left side in early 90’s then the right side in 2006::: I’m greatly declining and losing my ability to use my hands the severe nerve damage and atrophy. I was left handed and now can no longer do anything with the left just can barely write and then if it’s cold I cannot do that. It’s has seriously progressed over this last year and a half and continues to.

[@sarac.2601]

I have neurogenic TOS and have been told that it was DEPRESSION for about a year. I did pt for a year with no relief. I’ve gone through every testing above and told I am fine and pain meds, injections and stretching does not help.

[@LarryMorrow2]

According to Trail Guide to the Body 2nd edition, pretty old by now, 40% of the population (mostly women) have an additional scalene muscle. A middle Scalene. That makes for even less space for nerves, arteries, & veins to pass through. In Dr. Nabil Ebraheim's videos on the subject, he mentions the possibility of an elongated transverse process of a cervical vertebrae on his list of things to look for. Not just rib, clavicle, and extra muscle abnormalities. He has great advice to give, "always rule out double crush syndrome". It doesn't limit you to only two areas of entrapment, but means to acknowledge every possible site of entrapment along the entire nerve. Pronator Teres an elbow muscle is on the list, but not considered part of the thoracic outlet. Another video here on KZbin I like mentions EACH of the Thoracic Outlet Syndromes individually. Pectoralis Minor is one on the list. Those suffering for years, or even their entire life may just have one or more of the abnormalities I mentioned, and should still remember to "always rule out double crush syndrome". "I hope this helps you"

[@Yawasap144]

Smoke weed. No burning holes in your stomach, or internal bleeding, or withdrawal symptoms.

[@madeinhisimage3447]

KeSean Patterson sadly it made mine worse. For some reason right after I smoked it would hit me and the whole high I was painfully aware of the gnawing pain. And no one to help me rub it 😢

[@noahkennedy3588]

i was diagnosed with an extra cervical rib (left side) with the possibility of TOS i have been experiencing chest pain frequently, soreness under my left armpit an sometimes weakness in my left arm i went to a cardiologist for my chest pain an they did an ekg an came back good....so i’m just wondering is it possible for TOS to cause chest pain? Please respond with this epidemic going on in america it’s impossible to get responses, Thanks

[@JohnsHopkinsMedicine]

Hi Noah, Please reach out to inquire about a new appointment by calling 855-695-4872. Please note, many of our offices are reaching out to patients to reschedule appointments as video visits; this will depend on visit type and currently, these are only available for existing patients. Please call the above number to learn more about what options may be available for your specific situation. You can see more on our patient and visitor guidelines at www.hopkinsmedicine.org/coronavirus/index.html#patient-visitor-alerts

[@kaishanchua5958]

the answer is yes. usually you peck minor is tight. I have a scalene block injection for it today

[@MonkeyLuvAnimeXD]

I've recently found out that I have this syndrome. when I was 16 I got diagnosed with hearing loss due to TOS, and I'm now 17. I went to another hearing test and my audiologist said she wants me to go to a lot of follow ups with specialist, because it's so rare that it affects the bones in my ears. Is there an way to help fix my hearing loss? the pain and tingling in my arm is something I've learned to deal with, but I'm really worried that my hearing my get worse, as well is my audiologist.

[@cahillscourt]

Hopefully this guy can fix my guy markelle fultz. Dude used to be nice af before this

[@GaryJiangMusic]

Markelle Fultz

[@karlacervinkova2265]

Is here somebody who know if can be venous TOS symptoms: big And pain jugular vein if i am speaking And if i give my hand up?

[@killerkrocs3027]

Damn this actually real rip fultz

[@DL0AD1NG]

Markelle 🙏🏽🐐

[@TeamDoctorsAcademy]

This is an interesting view of thoracic outlet syndrome. However, what is missing is that muscle contractions or splinting spasms lift the rib up into the outlet and pull the shoulder down into the outlet. The proof this is the cause is that the surgeon removes the scalene muscles and the rib these muscles lift into the outlet. What is not mentioned is that the shoulder is also dragged into the thoracic outlet causing pressure on the nerves artery and vein and tat too is caused by contraction of the pectoralis minor, The surgical treatment is to surgically remove or cut the muscle. So if you have a spasmed, contracted muscle in your neck and shoulder do you cut it out or relax the muscle?

[@vending1872]

Cut the rib, CUT THE RIB.

[@annaraylie8149]

Can you examine a patient having there arm in different angels other then neutral position for example 90° or higher, even the patient sitting up having the arm for example 90° during ultrasound and if so is there a specific name for this examination?

[@bellaluhrs6456]

I was diagnosed this way. I’m curious too 🤔

[@tahuranaaz2044]

Hi I been diagnosed with TOS by a vascular surgeon recently. I have arm pain and also pain in my Thai and also looks like my right side of my face is drooping compared to my left side. The Dr. has schedule a CT scan on June. I wanted to get one more opinion. Can someone give me some advice on this issue.

[@tahuranaaz2044]

thigh* not Thai, sorry

[@talktolee5849]

I wonder if I have this I've been suffering for years 7 if I lay down a certain way I feel my heart rate go up then I get nausea, I've had 100 mri done with in the past 20 years , I do have tatinum in my neck I had 2 neck surgeries, I fell 8 years ago I landed on my left back shoulder I passed out from the pain in the fall but came to when my son found me , I don't think scapula pain in frozen shoulder has anything to do with my neck pain I also get pain in my arm pit left side my left scapula stick out my right is fine , this pain is so debilitating its truly making my life a living hell , but yet no one will help me one doctor said I have a significant amount of thorstic buldgers , I went to the brain in spine center of rhode island they gave me injection s they did not work I've had dry needling it helped a little , but I couldn't keep up going all the time , as soon as I stopped that the pain came back I can't do anything my health coverage sucks I think that is why doctors don't want to get to the root of the problem it truly sucks , I'm 57 I still have so much life but can't live it its sad my poor kids see me in pain all the time, I just want to not feel pain anymore , if anyone out there is going threw this can you please reach out to me, my poor daughter who is 21 years old is missing out , I have no quality of life , I need to fix this , before something bad happens please 💔 😢 it's terrible I don't know how people survive this pain , I'm not a week person I use to work out at the gym I was a dance teacher I was a very active person before this , ty lisa Dowiot

[@MacchiatoSwirlGirl]

Me too

[@wereyourangels]

My doctor read my x-ray and new what I had but never wanted to tell me so I didn't know, years later I found out it was TOS. Can you die from TOS due to not getting blood supply. I already have problems with my heart, I was told I'm not getting enough blood supply, than I get a heart attack. TOS is very serious and extremely painful, I can't move at all, I don't understand how people say you can do exercise when you can't move. TOS pain would travel to my back neck to the upper head giving me a headache, spine, shoulder, arm, and sometimes dizziness.

[@JohnsHopkinsMedicine]

HI, thank you for reaching out to us. We’re very sorry to hear about what you’re going through. Unfortunately, because each person’s medical situation is different, we are unable to provide treatment recommendations or second opinions via this form of communication.If you would like to request an appointment at one of our hospitals, please call 888-872-1408. Our specially trained medical concierges can arrange consultations or treatment plans with the most appropriate specialists. Johns Hopkins USA can also provide language interpretation, financial counseling, assistance with travel arrangements and anything else to help make Johns Hopkins feel as close to home as possible

[@oscarreed6629]

I want this guy!

[@dylanallen5653]

What do you consider heavy lifting ?

[@vending1872]

Effort

[@ShahrukhBhaiTech]

what is embolic disease and aneurysm? anyone?

[@JohnsHopkinsMedicine]

You can learn more here: www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-embolism and here: www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/types-of-stroke

[@SpaceTravel1776]

Markelle Fultz @ 4:15

[@amih2127]

I was told that nearly 80% of NTOS patients can get well with PT and medication but here in youtube seems TP is not effective and no one got better with PT and surgary is end of the road and pain. Im just hopeless

[@yashmahapatra3011]

Are you okay now?

[@amih2127]

@@yashmahapatra3011 i was diagnosed wrong. I have Ac separation

[@krystofphilipbobenrieth1029]

For anyone watching this that suspect that has TOs please research on ENVEST program PT. It could be a life-changing Factorfor you

[@elbignegro]

Markell Fultz

[@resisttrump4467]

Told to have this surgery. From and auto accident.

[@CollinAbbott1997]

I have a decent sized knot in subclavin vein area on right side of my body and that arm gets tired easily. I cleaned horse for years I think that’s what caused it. I need to get it checked out

[@NotoriousReviews23]

I have the same thing. Did you ever get it solved?

[@CollinAbbott1997]

Nope I just went to doctor last week and I asked him about it and he said its nothing to be worried about if it was bad something would have done happened

[@normnormlson7246]

Go Magic. Go John Hopkins Medicine .

[@JMixtapeProductions]

Here for Markele

[@fratertenc7589]

So some cases of TOS are not compressing arteries, right, doc? I'm worried about mine, but I"m glad I just figured out (presumtive diagnosis on my part) what has been causing my pain is Thoracic Outlet Syndrome. My right shoulder has always been crippled looking and 'lower'.. i've played piano and hunched over computers most of my 26 years of life so far. Theres a burning to sometimes sharp pain in the areas typically outlined on images showing the pain area.. the inner lower arm and out part of the hand and fingers up to the middle finger, it's like a muscle tightness or nerve pain that I can't twist myself out of. My neck itself deviates to the right (same side) which is interesting.. I suspect the neck stabilizing muscles are not working right due to nerve compresssion.. so that' my main question - could it be that it's just affecting nerves and not vessels/arteries? I'd hate to think this puts me at risk for heart attack or stroke. I'll go over my primary with this stuff, but I'd appreciate any feedback you may have based on my description.

[@AnkushDuttasuperstar]

Dr. James Stoxen DC, FSSEMM Hon FWSSEM I had it after my lymph node biopsy I cured cancer but I couldn't cure TOS. I did NCV EMG MRI CT scan all test doesn't show any unnatural defect. But I cannot lift my arm above shoulder. I have winged scapula while I train in gym I feel pain during my chest & shoulder excercise. I am an athlete what should I do none of the doctors are ready for surgery. I lost all hope.

[@FloRidaVEVO98]

@@AnkushDuttasuperstar do u still have problems?

[@AnkushDuttasuperstar]

Yes

[@MacchiatoSwirlGirl]

I've started intercostal injections , tried trigger points about 30xs. The intercostal injections worked a bit better dropped the flaired rib cage a bit, now he wants to inject subclavian shoulder area. My whole left arm is screwed up

[@redban3660]

What injections ?

[@ccampbell9598]

Red Ban this doc. Gave me injections and it didn’t work made it worst, would never see him again.

[@matineyang]

Botox injections in the scalene muscle I believe.

[@redban3660]

@@matineyang thank you

[@bellbott0mg757]

massage therapy !!

[@Ckelly192021]

hi sixers fans

[@moniquewrites9046]

Anyone here praying for Fultz?

[@KenTheMan407]

Fultz brought me here 😂

[@brucedickinson12]

wow a hospital named after a former moto gp motorbike rider

[@MultiMusik4]

is this operation free?

[@RAYTHYuen]

MultiMusik4 Nothing is free in this world. We all pay for it directly or indirectly via credit card, cash, or taxes.

[@constitutionalrepublican1611]

@@RAYTHYuen you forgot to say with your life, as people have died to end this, i am sure.

[@Primetime9292]

Constitutional Republican If I can’t find a proper diagnosis and treatment I’m heading that way. It’s completely ruining my life and I’m young.

[@constitutionalrepublican1611]

@@Primetime9292 i understand completely. the govt wants you to feel helpless, but you arent. i urge you to push yourself and to heal from within.

[@Primetime9292]

Constitutional Republican Fuck the government. I’m upset that I even have this problem and have to deal with shitty government health care and might have to seek benefits, which I have never wanted

[@denmarkpacs1575]

markelle fultz

[@Nostalgic-J]

See guys? It ain't markelle's fult... see what I did there?

[@luckycharms7232]

Fultz😢

[@TheSapientGod]

He looks like the man who would save the world from a horrible bioweapon

[@seal3081]

Please save Markelle Fultz. He broken.

[@Mrtamal01]

Here Becouse of that Tik tok dude.

[@nutsoutformikevi1013]

Markelle Fultz

[@GoogleMe_]

Markelle Fultz