Risk Factors

Symptoms

Thoracic Outlet Syndrome

(TOS)

Pronounced: tho-RASS-ik OUT-let SYN-drome

by Cynthia M. Johnson, MA

Definition

The thoracic outlet is the site of the lower neck and upper chest. It has a many nerves, blood vessels, muscles, and bones that run through a small site. Thoracic outlet syndrome (TOS) is when the nerves and blood vessels are squeezed, irritated, or harmed.

Thoracic Outlet Syndrome

Causes

TOS may be due to:

Defects in nearby structures
Trauma
Poor posture

Risk Factors

Your risk of TOS is raised if you have:

An extra rib or a first rib that is not typical
Trauma
Motions that you repeat often
Job problems, such as poor posture or using the computer too much

Symptoms

TOS may cause:

Arm or hand pain
Lack of arm or hand strength
Numbness and a feeling of pins and needles
Cold sensitivity in the hands and fingers
Pain or sores of the fingers
Poor blood flow to the arm, hands, and fingers
Swelling
Skin of arm turning pale and blue

Diagnosis

Your doctor will ask about your symptoms and health history. A physical exam will be done.

Your doctor will ask you to hold your arms and head in positions that may cause TOS. The results of these tests will help show whether you have TOS.

You may also have:

Blood tests
Electromyography and other tests of the nerves

Pictures may be taken with:

Chest x-ray
Ultrasound
CT angiography
MRI scan
Venography

Treatment

Treatment depends on the symptoms that you have. In most cases, TOS is treated with pain medicine and physical therapy.

Medication

You may need to take:

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Muscle relaxants
Antidepressants
Blood thinners
Anti-platelet medicines

Physical Therapy

A therapist will make an exercise plan. It will help to ease symptoms by relaxing nearby muscles, making your posture better, and easing pressure on nerves and blood vessels.

Lifestyle Changes

You may need to:

Avoid activity that causes pain.
Practice good posture.
Avoid repetitive motion.
Change your workstation layout.
Exercise regularly.

Surgery

If other treatments fail, your doctor may advise surgery. The goal is to move or remove the source of the pressure. In some people, this may mean taking out part or all of the first rib. This can make more room for the nerves and blood vessels.

Prevention

TOS can’t be prevented.

RESOURCES:

Occupational Safety and Health Administration
https://www.osha.gov

The Nicholas Institute of Sports Medicine and Athletic Trauma
http://www.nismat.org

CANADIAN RESOURCES:

Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Fugate MW, Rotellini-Coltvet L, Freischlag JA. Current management of thoracic outlet syndrome. Curr Treat Options Cardiovasc Med. 2009 Apr;11(2):176.

Povelson S, Povlsen B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics (Basel). 2018;8(1):pii E21.

Thoracic outlet syndrome. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at:
...(Click grey area to select URL)
Updated March 2018. Accessed March 17, 2020.

Thoracic outlet syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated December 22, 2014. Accessed March 17, 2020.

Thoracic outlet syndrome. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Thoracic-Outlet-Syndrome-Information-Page. Accessed March 17, 2020.

Vanti C, Natalini L, Romeo A, Tosarelli D, Pillastrini P. Conservative treatment of thoracic outlet syndrome. A review of the literature. Eura Medicophys. 2007 Mar;43(1):55.

Last reviewed March 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD
Last Updated: 3/17/2020

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