Thoracic Outlet SyndromeTreatment Without Surgery

Thoracic outlet syndrome (TOS) is a group of conditions caused by compression of the nerves, arteries, or veins in the space between the collarbone and first rib, known as the thoracic outlet. Neurogenic TOS, the most common form, involves compression of the brachial plexus and produces arm pain, numbness, and weakness that can closely mimic a cervical pinched nerve.

At Palm Beach Regenerative, Dr. Ghattas’s dual expertise in neurology and interventional pain management positions him ideally to evaluate and manage neurogenic thoracic outlet syndrome. Schedule an appointment with Dr. Ghattas today.

The thoracic outlet is a narrow passage between the collarbone, first rib, and surrounding muscles through which the brachial plexus nerve bundle and subclavian vessels pass. Compression in this space can produce a complex pattern of symptoms affecting the entire arm.

Neurogenic TOS is the most common type and is often associated with scalene muscle tightness, cervical rib variants, or prior shoulder and neck injuries.

• Aching pain in the neck, shoulder, and arm
• Numbness and tingling in the arm, often involving the ring and small fingers
• Arm fatigue with overhead activities
• Weakness of grip or fine motor function
• Symptoms worsening with prolonged computer use or overhead reaching
• Cold sensitivity in the hand in some cases

• Scalene muscle tightness or hypertrophy compressing the brachial plexus
• Cervical rib or fibrous band congenitally narrowing the thoracic outlet
• Poor posture with forward head and rounded shoulders
• Prior whiplash, shoulder injury, or clavicle fracture
• Repetitive overhead activities in athletes or overhead workers

TOS diagnosis requires a thorough clinical assessment including postural evaluation, special provocative tests (Adson’s, costoclavicular, EAST test), and neurological examination. Cervical MRI helps rule out concurrent cervical pathology, and electrodiagnostic testing assesses brachial plexus function.

Dr. Ghattas correlates all findings to distinguish neurogenic TOS from cervical radiculopathy and other causes of arm symptoms.

• Physical therapy focused on scalene stretching, postural correction, and first rib mobilization
• Scalene muscle injections with local anesthetic or Hyaluronic acid to reduce muscle compression
• Anti-inflammatory medications
• Surgical first rib resection or scalenectomy in refractory cases

Dr. Ghattas uses ultrasound-guided nerve hydrodissection around the brachial plexus at the scalene level, combined with targeted platelet injection to reduce the inflammatory environment contributing to nerve compression and irritation.

This approach addresses the neurogenic component of TOS through precise, image-guided technique rather than empirical treatment. It is combined with a structured rehabilitation program and the BioMod support protocols that are unique to Palm Beach Regenerative.