Thoracic Outlet Syndrome F100

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ICD Coding

ICD-10-AM Code: G54.0                  

Brief description

Thoracic outlet syndrome is a collection of symptoms and signs arising from the compression of nerves or blood vessels in the spaces between the collarbone and the first rib (the thoracic outlet).  Manifestations are variable (depending on whether arteries, nerves or veins are being affected). Symptoms and signs may be recurrent or occur suddenly. 

The different types of thoracic outlet syndrome are usually defined as:

• Arterial thoracic outlet syndrome (characterised by painful, numb, pale and cold affected arm or hand with associated weaker pulses)
• Neurogenic thoracic outlet syndrome (the most common type and often includes painful or abnormal sensations with numb or weak shoulder, arm or hand on the affected side)
• Venous thoracic outlet syndrome (often resulting in pain, bluish discoloration of the skin and swelling of the affected arm).

Thoracic outlet syndrome can sometimes result in serious complications involving blood clots.  

Confirming the diagnosis

The diagnosis is made from clinical evaluation, with imaging and other tests such as electrophysiological testing often required for confirmation.

The relevant medical specialist is a vascular surgeon or neurosurgeon

Additional diagnoses covered by SOP

• Arterial thoracic outlet syndrome
• Neurogenic thoracic outlet syndrome
• Venous thoracic outlet syndrome
• Mixed arterial/neurogenic thoracic outlet syndrome
• Paget-Schroetter syndrome
• McCleery syndrome

Diagnoses not covered by SOP

• Burners and stingers (transient brachial plexus neuropraxia) 
• Nerve root avulsion  
• Neuralgic amyotrophy  

Clinical onset

This condition can have an acute or gradual onset depending on the type of thoracic outlet syndrome involved. Symptoms and signs may present suddenly due to an event or develop as a result of recreational or occupational activities involving heavy lifting or repetitive overhead upper extremity motion.

Once the diagnosis has been confirmed, clinical onset can be dated to the onset of the first clinical event or presentation that is judged by a treating medical specialist to be related to the condition.

Clinical worsening

This condition can often respond well to treatment (conservative or surgical) but some may develop a chronic course. The same factors that can cause the condition can worsen it, if they continue to be present. Permanent worsening would be evidenced by uncontrolled pain, signs of permanent nerve damage, progressive upper extremity weakness and severe disability. Evidence of clinical worsening beyond the normal course of the condition is required.