Thoracic Outlet Syndrome Symptoms and Treatment

Thoracic Outlet Syndrome (TOS) is a group of disorders that occur when the nerves or blood vessels in the thoracic outlet compress. This is the space between collarbone and your first rib. This condition causes pain in your neck and shoulders and also numbness in your fingers.shoulder_thoracic_outlet_syndrome_causes03

There are three type of TOS. Neurogenic TOS, venous TOS and arterial TOS.

The thoracic outlet syndrome symptoms vary based on which structures are compressed.

Compression of the nerves can cause:

  • Tingling or numbness in your fingers
  • Hand or arm pain
  • Neck and shoulder pain
  • Weak grip

Compression of one or more of the arteries and veins can cause:

  • Subclavian vein thrombosis
  • Small black spots on your fingers
  • Hands turning to blue color
  • Arm swelling and pain, may be due to blood clotting
  • Fingers or your entire hand becomes pale
  • Throbbing lump near the collarbone

When TOS is left untreated, it can result in permanent damage to the nerves.

The main cause of thoracic outlet syndrome is compression of blood vessels and nerves in the thoracic outlet. But, there are various causes of compression, which include:

Poor posture

Holding down the head in forward motion or dropping the shoulders can cause compression in your thoracic outlet area.

Genetic defects

Congenital defects like cervical rib, an additional rib placed above first rib or unusually tight fibrous band that connect spine to your hand.


Traumatic events such as car accidents can cause internal changes that again compress nerves in the thoracic outlet.

Pressure on joints

Being overweight can put great amount of stress on your joints.

Repetitive activity

Repetitive activities can put pressure on the body tissues, for example, typing for longer periods, stocking shelves, or lifting things repeatedly above the head. Swimmers and baseball pitchers can also develop TOS.


Pregnancy causes your joints to become loose, so you will observe signs of TOS.

Early diagnosis and treatments can give relief from this condition. Most common conservative approaches for treating thoracic outlet syndrome include:


Relaxation technique that helps you is deep breathing. It keeps your shoulders away from becoming tense and reminds you to keep good posture.

Physical therapy

Your practitioner recommends some exercises that help to strengthen your shoulder muscles in order to open the thoracic outlet and to improve the range of motion, and improve posture.


Pain medications, anti-inflammatory drugs and muscle relaxants can reduce the inflammation and encourage muscle relaxation.

Surgery is recommended if you don’t notice any improvement in your symptoms or have major nerve damage, aggravate muscle weakness or severe pain. Most common surgeries include:

Transaxillary approach

Incision is made in your chest in order to access the first rib. Then the surgeon removes a part of first rib to relieve nerve compression. This surgery allows your surgeon to access the first rib without disturbing blood vessels and nerves.

Anterior supraclavicular approach

It repairs artery compression. Incision is made under your neck in order to show the brachial plexus region. Then your doctor can recognize the fibrous bands that cause nerve compression.

The early detection of the thoracic outlet syndrome symptoms helps you in treating the disease effectively and reducing the chances of surgical operations.