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Thoracic Outlet Syndrome (TOS)


Two Types: Vascular(5%) and Neurogenic (95%)


  • Numbness, tingling, burning, and weakness in the arm and hand.

  • Pain in the neck, upper back, shoulder, or arm.

  • Possible temperature changes and swelling in the hand due to irritated blood vessels.

  • Symptoms may be worsened by working with arms out in front, lifting the arm over the head (such as brushing hair), and repetitive activities (such as typing or computer use).


Interventions for TOS:

Scalene Injection (local anesthetic or botox)

Pectoralis Minor Injection (local anesthetic or botox)

T1 & T2 Paravertebral Nerve Blocks (for post operative pain control after surgery for TOS)

Articles by Dr. Kalava on TOS

Kalava A, Pribish AM. T1 Paravertebral Catheter for Postoperative Pain Management After First Rib Resection for Venous Thoracic Outlet Syndrome: A Case Report A & A Practice January 15, 2018 https://www.ncbi.nlm.nih.gov/pubmed/29634572

Kalava A, Camporesi E, Illig KA, Robards CB. T1, T2 paraverterbal blocks provide opioid sparing in first rib resection for thoracic outlet syndrome. J Clin Anesth. 2017 Dec 4;45:4-5 PubMed PMID: 29216506 https://www.sciencedirect.com/science/article/pii/S0952818017310954