Types of thoracic outlet syndrome

TOS is usually grouped as neurogenic (nerve-related) or vascular (blood vessel-related):

1. Vascular TOS: less common, involving compression of the subclavian artery or vein.
2. Neurogenic TOS: more common, involving compression or irritation of the brachial plexus nerves.

Can thoracic outlet syndrome cause dizziness?

It can, however it is not the most common feature. Some people feel light-headed when symptoms flare with overhead positions, neck rotation, or sustained postures. Because dizziness can also come from the neck, inner ear, blood pressure changes, or other causes, a clinician should screen for red flags and rule out other explanations.

Symptoms of thoracic outlet syndrome

Common thoracic outlet syndrome symptoms

• Upper limb pain, pins and needles, or numbness
• Pain that can radiate down the arm
• Symptoms that worsen with overhead work, lifting, or sustained posture
• Heaviness, fatigue, or reduced grip during activity

These symptoms can overlap with cervical radiculopathy, as well as other causes of neck and arm symptoms such as neck arm pain.

Vascular TOS symptoms

• Swelling, colour change, or visible vein changes in the arm
• Coldness, heaviness, or unusual fatigue with use
• Symptoms that increase with overhead positions

Neurogenic TOS symptoms

• Pain around the neck, shoulder, chest, or upper back
• Pins and needles into the hand or fingers
• Clumsiness with fine tasks or reduced coordination
• Muscle tightness and protective spasm around the neck and shoulder girdle

Risk factors

Several factors can contribute to TOS symptoms:

• Congenital anatomy (for example, an extra rib or fibrous bands)
• Previous trauma to the neck, shoulder, or collarbone region
• Repetitive overhead activity (sport, trades, gym training, some workplaces)
• Prolonged sitting, slumped posture, or sustained screen work
• Shoulder blade control deficits or reduced thoracic mobility

In practice, TOS often sits alongside shoulder overload conditions such as shoulder impingement, and rehab may also include scapular and rotator cuff exercises.

How is thoracic outlet syndrome diagnosed?

Diagnosis starts with a detailed history and physical assessment. A clinician may use posture screening, movement tests, neurodynamic testing, and symptom provocation positions to help identify the likely driver.

Imaging and tests may help rule out other causes, such as cervical spine issues or vascular conditions. Depending on your presentation, your doctor may request X-rays, ultrasound, MRI, nerve studies (EMG/NCS), or vascular studies. For a plain-language overview of TOS assessment and different subtypes, see the NCBI Bookshelf summary.

Treatment options

Physiotherapy for thoracic outlet syndrome

Many people start with conservative care. A physiotherapist may recommend a staged plan based on your irritability, work demands, sport, and symptom pattern. Common components include:

• Posture strategies for desk work, driving, and daily tasks
• Ergonomic assessment for home and workplace set-up
• Activity modification and load management (especially overhead work)
• Strength and control training for the shoulder blade and rotator cuff
• Thoracic spine and rib mobility work where appropriate
• Soft tissue techniques to reduce protective muscle tone
• Nerve mobility exercises when indicated

If your symptoms include mid-back stiffness or rib irritation, your physio may also screen for thoracic contributors and, where relevant, link your plan to broader upper back pain management.

Medical and surgical options

When symptoms persist, or when vascular signs appear, a doctor may recommend medication, targeted investigations, or referral to a vascular or surgical team. Surgery is not the first step for most people, however it may be considered in selected cases after appropriate assessment and a trial of conservative care.

What to do next

• If you notice arm swelling, colour change, severe weakness, or sudden worsening symptoms, seek urgent medical review.
• If symptoms flare with posture, overhead work, or training, book an assessment so you can identify the driver and start a plan that matches your day-to-day demands.
• Bring a short list of triggers (work tasks, gym movements, sleep positions). It speeds up the assessment and helps guide treatment.