Thoracic Outlet Syndrome

The thoracic outlet is the space between the upper chest and lower neck. It is the passageway of nerves and blood vessels between the first rib and collarbone. Thorarcic outlet syndrome (TOS) is an irritation, compression or injury to the nerves in this space.

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Signs and Symptoms

The most common symptoms of TOS include:

  • Pain in the neck, shoulder and arms
  • Numbness or reduced circulation in the neck, shoulder and arms

There are three different types of TOS depending on cause and location of the injury:

Neurogenic TOS is a result of abnormal bones or soft tissue in the lower neck, causing compression of the brachial plexus nerves. Symptoms often include:

  • Numbness or weakness in the hand
  • Smaller hand muscles

Venous TOS is a result of damage to the thoracic outlet veins, commonly after intense arm exercise. Symptoms often include:

  • Swelling in the arms, hands and fingers
  • Weakness in the neck and arms
  • Swelling of the veins in the front of the chest

Arterial TOS is a result of abnormal bone growth in the thoracic outlet region. It is present at birth. Symptoms often include:

  • Sensitivity in the hands and fingers, especially to cold temperatures
  • Numbness or pain in the fingers
  • Sores on the fingers
  • Reduced circulation in the arms, hands and fingers


Other conditions can cause the same symptoms, so it is important to check with your doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate thoracic outlet syndrome can make a firm diagnosis.

Diagnosis of thoracic outlet syndrome starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose TOS, including electromyogram , nerve conduction studies , magnetic resonance imaging (MRI), computed tomography (CT) and arteriogram .

Treatment options

There are different treatment options depending on the severity of your thoracic outlet syndrome:

  • Physical therapy
  • Medication
  • Thoracic outlet decompression surgery

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