Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) is a condition that occurs when nerves or blood vessels in the thoracic outlet, which is the area between the collarbone and first rib, become compressed. This compression can cause pain, numbness, and tingling sensations in the neck, shoulder, arm, and hand.

In this blog post, we will discuss what thoracic outlet syndrome is, its common signs and symptoms, how it can be treated, and relevant scientific literature published from 2015 to today.

What is Thoracic Outlet Syndrome?

TOS is a relatively rare condition that affects the nerves and blood vessels in the thoracic outlet region. The compression of these structures can cause a range of symptoms, including pain, numbness, tingling, and weakness in the affected areas. The condition can be caused by a variety of factors, including trauma, poor posture, repetitive motions, pregnancy, and anatomical abnormalities.

There are three main types of TOS –

  • Neurogenic TOS: Compression of the brachial plexus, a network of nerves that controls the movements and sensations in the arm and hand.
  • Venous TOS: Compression of the subclavian vein, which is responsible for carrying blood from the arm back to the heart.
  • Arterial TOS: Compression of the subclavian artery, which supplies blood to the arm.

Common Signs and Symptoms

The signs and symptoms of TOS can vary depending on the location and severity of the compression. Common symptoms include –

  • Pain in the neck, shoulder, arm, or hand
  • Numbness or tingling sensations in the fingers or hand
  • Weakness or fatigue in the affected arm
  • Swelling or discoloration of the arm or hand
  • Cold fingers or hands
  • Headaches or migraines
  • Fatigue or difficulty sleeping
  • Decreased range of motion in the shoulder or neck

How Can It Be Treated?

The treatment for TOS depends on the severity and type of the condition. In most cases, conservative treatments are recommended before considering surgery. Conservative treatments may include –

  • Physiotherapy to strengthen the affected area and improve posture
  • Anti-inflammatory medications to reduce pain and swelling
  • Nerve gliding exercises to improve nerve function
  • Ergonomic modifications to improve posture and reduce repetitive motions
  • Relaxation techniques to reduce stress and tension

If conservative treatments are not effective, surgical intervention may be necessary. Surgical options include –

Thoracic outlet decompression surgery to remove the pressure on the affected structures
Venous or arterial reconstruction to repair damaged blood vessels
Removal of a cervical rib, if present


Thoracic outlet syndrome is a relatively rare condition that affects the nerves and blood vessels in the thoracic outlet region. Common signs and symptoms include pain and dysfunction but with suitable guidance from a professional will assist your recovery.

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Scientific References

  1. Ferrante MA. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve. 2017 Nov;56(5):766-772. doi: 10.1002/mus.25645. PMID: 28370670.
  2. Rittirsch D, Radler C, Muscle Nerve. 2021 Feb 16. doi: 10.1002/mus.27324. Epub ahead of print. PMID: 33590516.
  3. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973 Nov 10;2(7835):359-62. doi: 10.1016/s0140-6736(73)91024-0. PMID: 4127578.