FEATURE | Posted Sept. 17, 2014

New thoracic outlet syndrome clinic opens

UC Davis specialists treat rare, complex vascular disorder

Dr. Freischlag with patient Amy Leach © UC Regents
A new clinic at UC Davis links experts from vascular surgery, pain medicine, and physical medicine and rehabilitation in providing complete evaluations and care for patients with thoracic outlet syndrome. Pictured from left to right are patient Amy Leach and physicians Misty Humphries and Julie Freischlag.

Amy Leach did something recently that she hadn’t done in three years — drive to visit her parents in Napa. Even more, she had enough energy to help clean up the damage to their home caused by the Aug. 24 earthquake.

She credits her renewed health to the UC Davis Vascular Center, where she was one of the first patients of a new clinic dedicated to treating a rare and complex disorder known as thoracic outlet syndrome (TOS).

“I feel better every week, and it makes me realize how incapacitated I was,” Leach said. “Everyone in my family and at work can see the improvement.”

It started with a car accident

TOS occurs when blood vessels or nerves running from the upper body to the arm become compressed, causing problems ranging from reduced mobility and pain to life- and limb-threatening blood clots. It is often related to trauma, repetitive movements or extra ribs that are present at birth.

Leach’s symptoms started with a car accident that left her with a broken neck and ribs. For years afterward, she had pain in an arm. She later became increasingly tired, had fainting spells and was often breathless. Sometimes, she heard a “whoosh” noise in her head.

“It didn’t all seem accident related, but that was definitely the starting point,” Leach said. “One symptom would be managed, then another would appear.”

Requesting an evaluation

TOS evaluations are scheduled at the UC Davis Vascular Center in Sacramento, Calif.,and can be requested by calling 1-800-4-UCDAVIS
(1-800-482-3284) and selecting option 2.

An internationally recognized expert

The clinic is led by Julie Freischlag who, in addition to being an internationally recognized vascular surgeon and TOS expert, is the vice chancellor for Human Health Sciences and dean of the School of Medicine at UC Davis. Freischlag links UC Davis experts from vascular surgery, pain medicine, and physical medicine and rehabilitation to provide complete evaluations and care for TOS patients.

As part of a comprehensive exam, Leach was asked to hold her hands above her head and move her fingers for two minutes. One hand turned white — a sign of limited circulation and distinguishing feature of TOS.

In addition to physical, exercise and pain-management therapies, surgery may be necessary to fully reduce compression and restore limb use. Freischlag is one of just a few U.S. surgeons who can treat TOS by removing the anterior scalene muscle in the neck and first rib through a small incision in the armpit.

Vascular graphic © UC Regents
Thoracic outlet syndrome occurs when the subclavian vein, subclavian artery or brachial plexus nerves located under the collarbone become compressed, leading to problems ranging from pain, swelling and reduced mobility to life- and limb-threatening blood clots. The condition can be surgically treated by UC Davis vascular specialists who, through a small incision in the armpit, remove the anterior scalene muscle and first rib, relieving compression of the vessels and nerves, improving circulation and alleviating pain. Subsequent physical therapy restores mobility and allows patients to return to routine activities.

Leach had the procedure on July 3, and her symptoms immediately improved.

“I feel unbelievably different, not just in my arm but overall, too,” she said. “Simple, everyday tasks that were extremely difficult are now possible and my energy is returning. I’m having a hard time pacing myself as I recover.”

The perfect place for a TOS clinic

One of Freischlag’s goals is to conduct education sessions to help physicians identify TOS. Nerve-related TOS — like Leach’s — can be difficult to diagnose, because it mimics orthopaedic conditions of the neck, spine and shoulder. Vascular TOS, which causes swelling, reduced blood supply and clots, is an acute condition that requires urgent surgical intervention.

“UC Davis’ interprofessional collaboration in patient care combined with its education focus and the expertise of its vascular center make it an ideal fit for a clinic dedicated to thoracic outlet syndrome,” said Freischlag. “Our commitment to research and discovery also means that we will be launching clinical trials to help us continue to refine treatments for these patients.”

In addition to Freischlag, the clinic team includes co-director and vascular surgeon Misty Humphries, other vascular center specialists and nurse Shirley Daffin. The health system’s telehealth network will support diagnosis and follow-up evaluations and reduce travel for patients who live outside of the region.