Thoracic Outlet Syndrome

Thoracic Outlet Syndrome


The thoracic outlet syndrome (TOS) is basically a group of disorders characterized by the compression of the blood vessels or nerves in the thoracic outlet, the space between the collarbone or clavicle and the first rib.

It is basically a complex form of repetitive strain injury involving the muscle, connective tissue, bones, blood vessels and nerves throughout the upper body.

There are generally three forms of the thoracic outlet syndrome, including:

  • Neurogenic (neurological) thoracic outlet syndrome
  • Vascular thoracic outlet syndrome
  • Non-specific type thoracic outlet syndrome

Research shows that this disorder is three times more prevalent in women than it is in men. Moreover, it is also more likely to occur in people with long necks and droopy shoulders.

Key Symptoms

The signs and symptoms of the thoracic outlet syndrome can vary according to the type and cause of the disorder. However, there are certain prominent signs and symptoms that are generally present in this disorder.

Here we list the most common symptoms associated with the thoracic outlet syndrome.

  • Numbness or tingling in the fingers
  • Pain in the shoulder and neck
  • Ache in hand or arm
  • Weakening of the grip
  • Frequent chills
  • Raynaud’s phenomenon
  • Swelling in the arm
  • Discoloration of the hand to bluish colour
  • Sensation of a throbbing lump near the collarbone
  • Tiny black spots on the fingers

Causative Factors

This disorder primarily occurs when the nerves and blood vessels from the chest to the arm are pinched. These nerves and blood vessels can get pinched under the collar bone, along the chest wall and in the neck muscles.

The main causative factors that could cause these nerves and blood vessels to get squeezed are:

  • Presence of an extra rib above the first rib
  • Abnormally tight fibrous band connecting the spine to the rib
  • Disc protrusion, herniation or degeneration
  • Fibrositis of the cervical and shoulder area
  • Poor posture, especially involving the shoulders and neck
  • Injury from a car accident
  • Excessive repetitive activity, generally as the part of a job
  • Excess bodyweight, exerting pressure on the joints
  • Pregnancy, causing joints to loosen

Diagnosgtic Tools

There are a series of tests that are often conducted to detect the presence of the thoracic outlet syndrome. Here we list the most important amongst them.

  • Adson’s maneuver
  • Wright test
  • Roos stress test
  • X-ray
  • Magnetic resonance imaging (MRI) scan
  • Electromyography (EMG)
  • Nerve conduction study

Treatment Options

There are various forms of treatment options available for the cure of thoracic outlet syndrome.

Here we briefly explain each of the treatment methods that effective in this disorder.

Conservative treatment

Conservative treatment generally includes three main steps including:

  • Physical therapy – Exercises like the Corner Stretch, Neck Stretch, Shoulder Rolls and Neck Retraction are often advised for relief from the symptoms of thoracic outlet syndrome.
  • Relaxation – Techniques such as deep breathing that can help in relaxing and help in keeping the shoulders from being tense are quite effective in the conservative management of this disorder.
  • Medications – Pain medications, muscle relaxants and anti-inflammatory drugs such as Advil, Motrin IB and the like are generally advised.

Surgical options

There are two main forms of surgical remedies available for the cure of the thoracic outlet syndrome, in case the condition doesn’t respond to the conservative methods.

These include:

  • Anterior supraclavicular approach
  • Transaxillary approach