Neurogenic Thoracic Outlet Syndrome (nTOS)

Neurogenic thoracic outlet syndrome (nTOS) is a condition caused by compression or irritation of the brachial plexus—the network of nerves that travels from the neck into the arm. This compression can lead to pain, weakness, numbness, and loss of function in the shoulder, arm, hand, and fingers. Because symptoms overlap with many other conditions, accurate diagnosis and expert evaluation are essential.

At NYU Langone Health, we offer a comprehensive, multidisciplinary approach to the diagnosis and treatment of nTOS. Patients benefit from a team of specialists working together to provide precise evaluation, targeted treatment plans, and advanced surgical options when needed.

nTOS can present with a wide range of symptoms, including:

• Neck, shoulder, or upper chest pain
• Numbness or tingling in the arm or hand
• Weakness or fatigue with overhead activity
• Loss of fine motor control in the hand
• Worsening symptoms with repetitive motion
• In advanced cases, intrinsic hand weakness or atrophy, sometimes referred to as Gilliatt–Sumner hand

Because symptoms can resemble cervical spine problems, carpal tunnel syndrome, or shoulder disorders, expert evaluation is critical. nTOS can also be confused with Parsonage-Turner syndrome — but unlike nTOS, which stems from physical compression of the nerves, Parsonage-Turner is an inflammatory condition that attacks them.

NYU Langone is one of the few centers in the region offering a fully integrated thoracic outlet syndrome program, allowing patients to receive comprehensive testing and care in one coordinated system.

Our team includes:

Vascular Surgery Specialists
Experts in evaluating arterial and venous forms of TOS using advanced diagnostic testing.

Musculoskeletal Radiology
Highly specialized radiologists provide dynamic imaging, nerve ultrasound, and targeted diagnostic blocks to clarify the source of symptoms.

Non-Operative Sports Medicine Team
Physicians trained in spine, sports, and peripheral nerve conditions who perform:

• Diagnostic injections
• Ultrasound-guided nerve blocks
• Tailored physical therapy programs
• Non-operative management plans

Thoracic Surgery
For cases requiring surgery, NYU Langone offers minimally invasive and robotic first rib resections, performed by internationally recognized thoracic surgeons such as Dr. Robert Cerfolio.

Robotic approaches may reduce postoperative pain, shorten recovery time, and improve precision.

Evaluation for nTOS may include:

• Detailed physical examination
• Dynamic ultrasound
• EMG/nerve conduction studies
• Targeted scalene or pectoralis minor anesthetic blocks
• MRI or CT imaging
• Assessment by multiple specialists in coordination

This multidisciplinary approach ensures that all potential causes of symptoms are evaluated thoroughly.

Most patients begin with nonoperative management, which may include:

• Specialized physical therapy
• Posture and biomechanics retraining
• Nerve gliding exercises
• Anti-inflammatory treatments
• Activity modification
• Diagnostic and therapeutic injections

For patients with persistent or severe symptoms—including documented nerve compression or progressive weakness—surgical decompression may be recommended.

This typically involves removal of the first rib and release of tight muscles or fibrous bands compressing the nerve structures.

At NYU Langone, many of these procedures are performed robotically, offering patients a modern, less invasive option for thoracic outlet decompression.

With experts in hand surgery, vascular surgery, thoracic surgery, sports medicine, and musculoskeletal radiology, the NYU Langone TOS program provides the highest level of diagnostic accuracy and tailored treatment.

Patients with complex nerve-related symptoms benefit from coordinated multidisciplinary evaluation and treatment plans designed to restore function and improve quality of life.

To learn more, visit the NYU Langone Thoracic Outlet Syndrome Program