Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

John Miller Physiotherapist

Article by John Miller

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome (TOS) compresses nerves or blood vessels as they exit the neck and shoulder region. The subclavian artery, vein, and lower roots of the brachial plexus often bear the brunt of this compression.

Key Areas of Compression

Three primary areas typically experience compression:

  1. Between the neck’s anterior and middle scalene muscles
  2. Between the collarbone and the first rib
  3. Underneath the coracoid process of the shoulder blade

Such compression results in symptoms like pain, numbness, and tingling. Effective diagnosis and treatment are vital for managing TOS symptoms.

Types of Thoracic Outlet Syndrome

TOS mainly falls into two categories: Vascular and Neurological.

  1. Vascular TOS: This rare type makes up just 2% of cases and compresses blood vessels like the subclavian artery or vein.
  2. Neurological TOS: Accounting for 98% of cases, this category has two subtypes:
    • True Neurological TOS: Bony or soft tissue anomalies cause nerve compression.
    • Symptomatic TOS: Repetitive activities or postures result in intermittent nerve and vessel compression.

Correctly identifying the TOS type is crucial for choosing the best treatment path.

Symptoms of Thoracic Outlet Syndrome

thoracic outlet syndrome
Thoracic Outlet Syndrome (TOS)

Common Thoracic Outlet Syndrome Symptoms

  • Upper limb pain and altered sensations
  • Pain radiating down the arm
  • Changes in arm and hand temperature

These symptoms often worsen when lifting the arm or turning the head and can mimic other conditions like cervical radiculopathy.

Vascular TOS Symptoms

  • Pins and needles in the arm and hand
  • Weak or absent arterial pulse
  • Swelling and colour changes in the arm

Neurological TOS Symptoms

  • Pain in various upper body areas
  • Pins and needles in the fingers
  • Muscle spasms and hand coordination loss

Proper diagnosis and treatment by healthcare professionals are essential for effective symptom management.

Risk Factors for Thoracic Outlet Syndrome

Several factors can contribute to TOS:

  • Bony abnormalities such as an abnormal first rib
  • Trauma to the neck or shoulder
  • Overhead repetitive movements
  • Poor posture
  • Weight gain

Diagnostic Procedures

Medical professionals may conduct cervical spine X-rays and other tests like MRI or EMG to rule out other causes for the symptoms.

Treatment Options for Thoracic Outlet Syndrome

Physiotherapy for Thoracic Outlet Syndrome

Effective physiotherapy treatment depends on a thorough evaluation and personalised plan, often involving:

  • Posture correction advice
  • Ergonomic assessment of work or home settings
  • Activity modification to aid healing
  • Strengthening exercises for shoulder stabilisers
  • Spinal and rib mobilisation
  • Tension-relieving massages
  • Exercises to improve nerve mobility

Surgery for Thoracic Outlet Syndrome

If conservative treatments fail, surgery may be an option. The effectiveness of treatment varies, so tailored plans and follow-up care are critical.


In conclusion, Thoracic Outlet Syndrome is a complex condition that can significantly impact the quality of life. Understanding the nature of TOS, recognising its symptoms, and being aware of the risk factors are important steps in managing this condition. Timely and accurate diagnosis is crucial, as it informs the appropriate treatment approach, whether that’s physiotherapy or, in more severe cases, surgical intervention. With the right care and attention, individuals suffering from TOS can manage their symptoms effectively and improve their daily functioning. Remember, if you suspect you have TOS, consult a healthcare professional for a tailored treatment strategy.


  1. Dengler, N. F., Ferraresi, S., Rochkind, S., Denisova, N., Garozzo, D., Heinen, C., Alimehmeti, R., Capone, C., Barone, D. G., Zdunczyk, A., Pedro, M. T., Antoniadis, G., Kaiser, R., Dubuisson, A., Kretschmer, T., & Rasulic, L. (2022). Thoracic Outlet Syndrome Part I: Systematic Review of the Literature and Consensus on Anatomy, Diagnosis, and Classification of Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies’ Section of Peripheral Nerve Surgery. Neurosurgery, 90(6), 653–667.
  2. Peek, J., Vos, C.G., Ünlü, Ç., van de Pavoordt, H.D.W.M., van den Akker, P.J. and de Vries, J.-P.P.M. (2017). Outcome of Surgical Treatment for Thoracic Outlet Syndrome: Systematic Review and Meta-Analysis. Annals of Vascular Surgery, 40, pp.303–326. doi:

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