Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is an umbrella term for a group of related disorders originating between the ribs and collar bone, an area known as the thoracic outlet. These conditions occur when the collarbone or topmost rib presses down on nearby blood vessels and nerves, causing a variety of painful and serious symptoms.

What You Need To Know About Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome is the name given for a group of related disorders. TOS conditions result from the compression of nerves or blood vessels in the area between your first rib and collarbone. Injury to this area can cause shoulder and neck pain, as well as finger numbness.

There are three subcategories of thoracic outlet syndrome. They include neurogenic, vascular/venous, and arterial.


Neurogenic is the most common type of thoracic outlet syndrome. The condition is characterized by compression of the nerves that lead from the neck to the arm. This network of interconnected nerves controls muscle movements and sensations in your hand, arm, and shoulder. When compression disrupts this network, you may experience nerve irritation and abnormal sensory function in your upper limbs.


These two related conditions result from injury to the veins in the upper chest and lower neck. Vascular is characterized by compression of the veins or arteries under the collarbone.

Venous thoracic outlet syndrome occurs when the clavicle pinches the vein, causing upper body thrombosis. Both of these conditions manifest without warning as a result of overexertion of the arms.


Arterial thoracic outlet syndrome occurs when an abnormal bone structure or other element presses down an artery. Bony abnormalities that occur at birth in the lower and upper chest can cause arterial TOS. It is the least common type of syndrome, and it is the most severe.

Understanding the cause of pain is crucial to getting relief. Schedule an appointment to talk with one of the experts at Resurgens Orthopaedics today.

What Causes Thoracic Outlet Syndrome?

There are many causes of thoracic outlet syndrome. Some people develop the condition as a result of physical injury from auto accidents. Athletes may develop TOS from sports that involve repetitive shoulder and arm movements. Occupations that require an excessive amount of similar motions can also cause the development of TOS.

Others still may have thoracic outlet syndrome due to anatomical differences at birth, such as having an extra rib (known as a cervical rib,) having an extra neck muscle, or overly taut connections between the rib and spine. Any condition that causes the blood vessels and nerves to be overly-compressed can cause TOS. Sometimes doctors are unable to diagnose the cause of the syndrome.

Some lifestyle activities that can contribute to the development of TOS include:

  • Bad posture

  • Improper posture during bodybuilding, swimming, or baseball

  • Overhead motions as a result of occupations like hairstylist and auto mechanic

Thoracic Outlet Syndrome Symptoms

For people experiencing nerve compression, you may have a weak grip or tingling and numbness in your arms. Pain may radiate from your hand to your neck.

If you are experiencing blood vessel compression, your hand or arms may experience feeling cold or frail. Additionally, the skin on your hand may have a bluish appearance, with your arm experiencing pain and swelling. For blood vessel compression, upper body blood clots are possible as well the appearance of lumps by your collarbone under your skin.

Symptoms for TOS vary according to what part of the body and related structures are affected:

Symptoms of Neurogenic Thoracic Outlet Syndrome

Symptoms of neurogenic TOS include:

  • Feelings of weakness or pain in the arm and shoulder

  • Discomfort and tingling in the fingers

  • Arms that quickly feel tired

  • Atrophy in thumb pad and the palm muscle leading to the thumb

Symptoms of Vascular/Venous Thoracic Outlet Syndrome

Symptoms of vascular/venous TOS include:

  • Swelling (edema) of the hand, arm, or fingers

  • Arm or hand appearing bluish, with painful tingling

  • Visible protruding veins in the hand, neck, and shoulder

Symptoms of Arterial Thoracic Outlet Syndrome

Symptoms of neurogenic TOS include:

  • Pale or cold hands

  • Hand or arm pain during arm motion

  • Increased risk of embolisms and aneurysms

Your Resurgens physician will be able to provide a more thorough evaluation of your condition and symptoms.

How Thoracic Outlet Syndrome is Diagnosed

Diagnosing TOS starts with a visit to a Resurgens physician. During this appointment, your physician will review your medical history, relevant family history, and conduct a physical examination. Because symptoms vary widely between people, it can be challenging to diagnose TOS.

Your doctor will start by performing a physical examination of your body. During this exam, they are looking for external evidence of TOS like shoulder depression, pale or swollen arms, or compromised levels of motion. Be prepared to answer questions about your symptoms, occupation, and lifestyle activities. You may experience some slight irritation as your doctor asks you to replicate scenarios that trigger your pain.

In addition to provoking your symptoms, your doctor will use diagnostic imaging to rule out conditions that may be causing similar symptoms. The use of these tools can help doctors understand the underlying causes of TOS. Without a thorough understanding of your situation, your doctor can't create an effective treatment plan. Your doctor will use this information to create a treatment plan tailored to your condition.

Treatment for Thoracic Outlet Syndrome

There are different intervention options, whether you're suffering from neurogenic, vascular/venous, or arterial thoracic outlet syndrome. Treatment for TOS varies according to your specific needs and the extent of your condition.

Your doctor will determine the best level of response based on the extent of your condition and your lifestyle goals.

Neurogenic Thoracic Outlet Syndrome Treatment

Conservative neurogenic TOS treatments include physical therapy, nerve block injections, and other injectable medications. Also, the use of over-the-counter and prescription pain relievers can help you cope with your symptoms. Be careful with these medications as they can be habit-forming.

For extreme conditions, your doctor may recommend surgical procedures. Surgical procedures can help to decompress the excess pressure on the affected area.

Vascular/Venous Thoracic Outlet Syndrome Treatment

Vascular/Venous TOS treatments usually involve surgery. Surgery involves removing redundant muscle and bone. It may also include repairing the affected vein. Before your surgery, your doctor may prescribe anticoagulants and blood clot medicine.

Arterial Thoracic Outlet Syndrome Treatment

Arterial TOS treatment usually involves surgical intervention. During these procedures, a surgeon removes excess bone or muscle. These components will not constrict your artery once they are out of the way. Some patients may need to receive angioplasty to prevent future blood clots from forming.

Getting the right treatment for your condition involves talking to an expert. Book an appointment with the professionals at Resurgens Orthopaedics to speak to a physician!

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