Thoracic Outlet Syndrome (TOS) Duplex Ultrasound


  • Arterial trauma post fractured clavicle
  • Exercise related limb pain, Pain and paraesthesia in the hand, neck, shoulders or arms
  • Arm fatigue which varies with different anatomical positions
  • Raynaud’s phenomenon
  • Muscle atrophy of the hand
  • Oedema/swelling of the arm or hand
  • Follow-up limb revascularisation, vessel reconstruction, intravascular stent

Contraindications and limitations:

  • Extreme arm girth (obesity, excessive musculature or extreme oedema)
  • Site trauma such as open wounds in the scanning area
  • Casts or dressings that cannot be removed
  • Patients that cannot be adequately positioned or perform provocative manoeuvres

Patient preparation:

  • Eat breakfast, lunch or a snack within 3 hours prior to attending the ultrasound appointment.
  • Be well hydrated. Please ensure 500ml-1500ml of water has been consumed prior to the ultrasound, unless underlying medical condition require you to reduce your fluid intake. Please note: Coffee, tea and alcoholic drinks are dehydrating; these drinks are not included in the 500-1500mls of water. WHY? This increases the blood volumes which allows for improved visualisation of the vessels.
  • On the day of the ultrasound, refrain from applying oils or moisturisers to the lower limb


What to wear:

Loose-fitting clothes, for example; loose-fitting top, sleeveless top.

Ultrasound study technique:

This is a non-invasive diagnostic study. The patient will lie on a bed, with the head of the bed flat, with the arm resting on the bed or on a pillow, or siting in a chair. Ultrasound gel will be applied to the clavicular region (collar bone region) and the medial shoulder (the side closest to the head). An ultrasound probe will be run from the clavicular region, through to the shoulder, in the resting position. The arteries and veins will be assessed for their diameters and spectral Doppler waveform velocities, at 3 to 4 different anatomical locations. This will be repeated with the arm positioned in 5-6 standard provocative manoeuvres plus, if possible, in the position that produces the patients symptoms. This is repeated on the contralateral (other) side, if requested. Images will be obtained, and the results, documented on a worksheet.

Ultrasound study time:

30 minutes per side.


A worksheet can be available, if requested. A formal written report will be available within 24 to 48 hours, following the ultrasound examination, Monday to Friday. If the ultrasound findings demonstrate pathology, which may require urgent attention, the referring Doctor will be notified ASAP following the completion of the ultrasound.