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A definitive diagnosis of thoracic outlet syndrome (TOS) is often not possible. Many TOS cases are diagnosed by ruling out other causes (e.g., herniated disc, carpal tunnel syndrome, acute coronary syndrome). The physician will take a medical history of the patient that includes when the symptoms began and whether the patient has had any accidents or trauma in the past. Before seeing the physician, it is helpful to write down at what times and during which activities the symptoms appear.
A physical examination will be performed, in which the physician will try to reproduce the symptoms of TOS by examining the patient’s range of motion (e.g., rolling or tilting the patient’s head to one side and/or holding the patient’s arms up to reproduce the symptoms). The physician will look for swelling or discoloration in the arm or a depression in the shoulder.
Other diagnostic tests include:
- X-ray. A painless test in which an image is created of part of the body by using low doses of radiation reflected on film paper or fluorescent screens. This test may show structural abnormalities, including rib malformations, that may contribute to TOS.
- Nerve conduction studies (NCS). A test of nerve function in which a nerve is stimulated with electric current after placement of electrodes on the skin. Patients may find the sensation unusual but generally not painful. This test is generally used to rule out other nerve-related conditions.
- Electromyography (EMG). A test of electrical activity in muscle. EMG involves insertion of thin needles in the muscle and can cause discomfort and bruising.
- Magnetic resonance imaging (MRI). A safe and painless test that produces very clear cross–sectional or three–dimensional images of the body’s tissues, even through bone and other obstructions. An MRI may be used to rule out other causes.
- Duplex ultrasound. Similar to an echocardiogram, Duplex ultrasound is a non–invasive vascular test that uses sound waves to visualize circulation within blood vessels. This test is useful to determine if an artery or vein is being compressed, which may help diagnose arterial or venous TOS.
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