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Thoracic Outlet Syndrome

Verified By Dr Pereddy Somashekara Reddy August 25, 2021 4647 0
Thoracic outlet syndrome
Thoracic outlet syndrome

Thoracic Outlet Syndrome (TOS) is not a life-threatening disease, but if it is left untreated, it can surely cause certain chronic complications. 

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome is not a single disease but a group of disorders that happen when nerves or blood vessels in the area between collarbone and the first rib (thoracic outlet) are compressed. Repetitive injuries, physical trauma, and anatomical disorders can cause this disease to develop. 

There are numerous types, including:

  1. Neurological (Neurogenic) Thoracic Outlet Syndrome: This is the most common type of thoracic outlet syndrome. It is characterized by compression of your brachial plexus, a network of nerves that control muscle movements and sensation in the arm, shoulder and hand
  2. Nonspecific-type thoracic outlet syndrome.  Hose with nonspecific-type thoracic outlet syndrome suffer from chronic pain in the thoracic outlet area which worsens with physical activity. However, a specific cause of the pain cannot be determined.
  3. Vascular thoracic outlet syndrome. In this type, the thoracic outlet syndrome happens when one or more of the arteries (arterial thoracic outlet syndrome) or veins (venous thoracic outlet syndrome) or under the collarbone (clavicle) are compressed.

What are the Symptoms of Thoracic Outlet Syndrome?

The symptoms of TOS are not the same for everyone. Depending on which nerve or artery is compressed, the symptoms vary. Symptoms include:

When nerves are compressed, the symptoms of neurological thoracic outlet syndrome include:

  • Aches or pain in your hand, neck or shoulder 
  • Gilliatt-Sumner hand (muscle wasting in the fleshy base of the thumb)
  • Weakening grip 
  • Tingling or numbness in your arm or fingers
  • Symptoms of vascular thoracic outlet syndrome may include:
  • Arm pain and swelling, potentially owing to blood clots
  • Discoloration (bluish color)of the hand 
  • pallor (lack of color) in one or more of the fingers or your entire hand 
  • Blood clot in the arteries or veins in the upper area of the body
  • Weak or no pulse in the affected arm
  • Cold arms, hands or fingers
  • Arm fatigue due to activity
  • Tingling or numbness in the fingers
  • Throbbing lump near your collarbone
  • Weakness of neck or arm

Also Read About: Blood Clot in The Brain

When Should You See a Doctor?

If you experience any symptoms mentioned above, you must visit a doctor right away. 

What are the Risk Factors and Causes  of Thoracic Outlet Disease?

More than men, women are likely to be affected by this disease. If you are a lady between 20 and 40 years, there are high chances of developing thoracic outlet disease. The most serious complication of the disease is progressive nerve damage. It happens when a person suffering from TOS leaves the condition untreated for a long time.


  • Anatomical defects: Congenital defects or inherited defects present at birth may have an extra rib located above the cervical rib (first rib) or an abnormally tight fibrous band connecting the spine to your rib.
  • Poor posture 
  • Trauma
  • Repetitive activity: If you are in a job that requires you to repeat a movement continuously like working on an assembly line, or typing on a computer system, or lifting things above the head, or if you are a swimmer or a baseball pitcher.
  • Pressure on your joints. Being obese can also put an undue amount of stress on the joints, as can carrying an oversized bag or backpack around.
  • Pregnancy. As joints get loosened during pregnancy, signs of thoracic outlet syndrome may appear first while you are pregnant.

Doctors will give you medication to reduce the severity of the disease. However, in case the medicines prove ineffective, doctors recommend surgery to cure this illness. 

How to Prevent Thoracic Outlet Syndrome?

Getting treated promptly after being diagnosed with TOS disease is the best way to prevent it from damaging your nerves. If the doctor suspects TOS, avoid lifting heavy objects and do not perform any repetitive movements. Sometimes obesity also causes this disease. Hence, it is better to lose weight and maintain a healthy weight based on your body type.

If you do not have TOS, you can follow certain measures to prevent its occurrence. Avoid carrying heavy objects on your shoulder because that increases the probability of developing this disease. Perform daily stretches and regular exercise that focus on your neck, chest, shoulder, and muscles. 

How is Thoracic Outlet Syndrome Treated?

  1. Physical therapy is your first treatment option for TOS. You will be taught exercises that improve your posture and widen your shoulder muscles.
  2. Anti-inflammatory medications, muscle relaxants, and pain medications will reduce pain. These drugs will also reduce inflammation and energize your muscles.
  3. Your doctor may also recommend you thrombolytic medication to dissolve the blood clots resulting from TOS. You will then be prescribed anticoagulant medications to prevent future blood clots.

thoracic outlet decompression is the surgery to treat thoracic outlet syndrome. It is performed using several different approaches, such as:

  1. Supraclavicular approach
  2. Transaxillary approach
  3. Infraclavicular approach

In arterial or venous thoracic outlet syndrome, the surgeon may deliver medicines to dissolve blood clots before thoracic outlet compression. If you are having arterial thoracic outlet syndrome, your surgeon may have to replace the damaged artery with a section of the artery from other part of the body (graft) or artificial graft.


Symptoms linked to thoracic outlet syndrome can be caused by numerous other conditions that may make it difficult for doctors to diagnose these condition. Many people experience the symptoms of thoracic outlet syndrome for years before they are diagnosed with this condition, which may cause stress and frustration. 

Frequently Asked Questions (FAQs)

What kind of exercises is the best to treat thoracic outlet syndrome?

You have to exercise that stretches ans strengthens theshoulder muscles to open the thoracic outlet and improve your your posture as well as range of motion. Done over time, these exercises may take the pressure off the blood vessels and nerves in the thoracic outlet.

What are some tests that doctors use to diagnose TOS?

Some major tests that doctors use to diagnose TOS are X-rays, ultrasound, angiography, MRI, electromyography, CT scan, arteriography, venography, and nerve conduction study.

What is a provocation test?

The doctor will try to trigger your TOS symptoms to confirm you have the disease in this test. You will be asked to move your neck, shoulder, and head in various directions, and the doctor will note your symptoms. 

Verified By Dr Pereddy Somashekara Reddy
MBBS, M.S. Ortho, M.Ch Ortho Fellow Arthroplasty (joint replacement surgery) USA, Consultant Orthopaedic Surgeon Specialist in Arthoplasty, Arthroscopy, Trauma, and Spine, Apollo Hospitals, Jubilee Hills, Hyderabad

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