Symptoms of Arterial TOS

Arterial TOS is rare and quite serious. The symptoms of arterial TOS are often sudden and severe. These symptoms are caused by sudden occlusion of one or more arteries in the affected arm. Arterial occlusion blocks blood flow to the arm, which may lead to severe complications if not diagnosed and treated promptly.

Symptoms of Arterial TOS

Symptoms of Arterial TOS

Patients with arterial TOS may present with acute arterial occlusion, local symptoms, intermittent arterial insufficiency, or chronic arterial insufficiency.

Patients with acute arterial occlusion may experience one or more of the 5 P’s:

  • Pain
  • Pallor
  • Paresthesias
  • Pulselessness
  • Paralysis

Patients with these symptoms should seek immediate medical attention.

Local symptoms may include an aneurysm or a cervical rib. A patient may notice a cervical rib as a chronic hard lump at the base of their neck. A patient may feel a painless, pulsatile mass at the base of the neck. This pulsatile mass may represent a normal subclavian artery passing over a cervical rib, or a subclavian artery aneurysm.

Intermittent compression of the subclavian artery causes symptoms only in specific arm positions; in other words, symptoms only occur in those arm positions where extrinsic structures compress the artery. Some patients notice their arm “going to sleep” in certain arm positions, or when they wake up from sleep.

Chronic or intermittent compression of the artery may cause scar or stenosis of the artery. As a result, chronically limited blood flow could cause chronic arm fatigue. Under those circumstances of chronically limited blood flow, the patient would experience claudication.

Claudication is a symptom complex resulting from narrowing of a major artery, usually to an arm or a leg. Symptoms of claudication usually progress over time.

  • Pain during exertion: A patient has adequate blood flow at rest, but arterial stenosis or compression limits the increased flow required during significant exertion. Thus, the patient notes symptoms only during exertion. Pain during significant exertion may therefore be the first sign of arterial stenosis or compression.

  • Intermittent pain: Progression of  the degree of arterial stenosis or compression causes greater limitation of blood flow. The patient experiences pain with only mild exertion.

  • Pain at rest: When arterial stenosis or compression becomes severe enough, limitation of blood flow occurs even at rest. Thus, the patient notes almost constant pain.

  • Skin changes: Chronic severe limitation of arterial blood flow causes trophic changes to the skin of the affected area. The skin in the affected area becomes smooth, shiny and hairless. Small skin ulcers or areas of discoloration may form in the affected arm or fingers. The skin may feel cold to the touch.

Diagnosis of Arterial TOS

Your doctor will find evidence of arterial occlusion, including a cold and pulseless arm. Imaging tests can quickly and accurately demonstrate the presence of arterial aneurysm, blood clot, and occlusion. Learn more about the clinical diagnosis and imaging diagnosis of arterial TOS here.

Treatment of Arterial TOS

Critical treatment decisions revolve around the presence or absence of a blood clot causing arterial occlusion. When present, acute arterial occlusion demands urgent treatment. When absent, surgeons can assess and treat patients with arterial TOS less urgently. Learn more about the treatment of arterial TOS here.