Thoracic Outlet Syndrome (TOS)

Relief for Thoracic Outlet Syndrome Starts Here 

Thoracic Outlet Syndrome (TOS) is a complex condition that can be difficult to diagnose and even harder to manage without the right team behind you. At Guthrie, a dedicated, multidisciplinary TOS clinic gives patients access to standardized, coordinated care, from evaluation through treatment, all within one trusted health care system. 
 

If you are experiencing arm pain, numbness or circulatory changes, you do not have to navigate this condition alone. The Guthrie TOS clinic brings together specialists across disciplines to ensure that every patient receives coordinated, individualized care.

 

A Team Built Around You 

Dr. John K. Sadeghi, 
Thoracic Surgery 

Clinical Lead 
Dr. Sadeghi is a specialist in thoracic and foregut surgery at Guthrie Robert Packer Hospital and serves as the clinical lead for the TOS clinic. He performs the robotic first rib resection procedure and oversees surgical evaluation and management for TOS patients. Patients can schedule a consultation directly with Dr. Sadeghi. 

Dr.Dana LaVanture, Orthopedics/Hand Surgery 

Dana LaVanture brings expertise in orthopedics and Carpal Tunnel Syndrome to the team, supporting patients whose symptoms affect hand and arm function in daily activities. 

Jim Wagner, Occupational Therapy 

Jim Wagner is a key member of the TOS clinic team and leads the therapy component of care. He works closely with Dr. Sadeghi and the broader team to evaluate and treat patients using standardized, evidence-based protocols. 


Please note: The Guthrie TOS clinic is distinct from Guthrie's Peroral Endoscopic Myotomy (POEM) procedure and esophageal motility program. 


Recognizing the Symptoms 

The thoracic outlet is the space between your collarbone and first rib. There are three distinct types of thoracic outlet syndrome (TOS), each involving different structures and presenting with different symptoms. Symptoms vary depending on which structures are affected. 
 

Neurogenic TOS 

  • Pain, numbness or tingling in the neck, shoulder, arm or hand. 

  • Weakness in the hand or arm. 

  • Worsening symptoms with overhead activity or prolonged arm use. 
     

Venous TOS 

  • Swelling, heaviness or discoloration of the arm. 

  • Visible veins near the shoulder or chest. 

  • A feeling of fullness in the arm, particularly with activity. 
     

Arterial TOS 

  • Cold or pale hand or arm. 

  • Weak or absent pulse in the arm. 

  • Pain or fatigue in the arm with use. 
     

How Guthrie Treats Thoracic Outlet Syndrome 

Treatment depends on the type and severity of your TOS, as well as your individual health history. The Guthrie TOS clinic uses a structured, evidence-based approach to guide patients through the appropriate care pathway. We utilize a multi-disciplinary approach to treating thoracic outlet syndrome. Treatment can involve physical therapy, Botox injections, consultation with vascular surgery or hand surgery specialists, coordination with sports medicine physicians and neurologists and robotic first rib resections with a thoracic surgeon.  
 

Robotic First Rib Resection 

For patients who meet surgical criteria — typically those who have not improved with conservative management and who have confirmed structural compression — Dr. Sadeghi offers a minimally invasive, transthoracic robotic first rib resection. This approach removes the first rib through the chest using robotic instrumentation, avoiding critical structures while allowing for a more precise and less disruptive operation. Patients experience a rapid recovery, including a short hospital stay with chest tube management before discharge. 
 

All clinical information on this page is intended for general patient education. Please consult your Guthrie care team for guidance specific to your condition. 

Frequently Asked Questions

FAQ

  • Can I schedule a consultation on my own, or do I need a referral? 

    • You can self-schedule a consultation directly with Dr. Sadeghi.  
       

  • How is neurogenic TOS diagnosed? 

    • After evaluation by a team member, additional testing or consultations are scheduled with planned follow-up.  
       

  • Will I Need Surgery? 

    • Not necessarily. The majority of TOS patients begin with physical or occupational therapy and many experience significant improvement without needing surgical intervention. Surgery is considered only when conservative treatment has not provided adequate relief and when the patient meets appropriate clinical criteria. 
       

  • What makes the robotic approach different from traditional surgery? 

    • The transthoracic robotic first rib resection uses robotic instrumentation to remove the first rib through the chest with greater precision and less disruption to surrounding tissue than traditional open surgery. This approach is designed to minimize recovery time and reduce the risk of complications. 

Take the First Step Toward a Diagnosis  

Living with unexplained arm pain, numbness or circulation changes is frustrating, especially when answers are hard to find. Guthrie's multidisciplinary TOS clinic is here to help you understand what is happening and determine the right path forward. 

Call 570-887-2300 to schedule a consultation today.