What is Thoracic Outlet Syndrome (TOS)?

Thoracic outlet syndrome is a group of disorders that occur when nerves or blood vessels in the area between your collarbone and first rib (thoracic outlet) are compressed. This narrow passageway is crowded with blood vessels, muscles, and nerves. This generally causes pain in your shoulders and neck and numbness in your fingers. Diagnosing can be very difficult and is often confused with carpal tunnel syndrome, frozen shoulder, brachial plexus syndrome, rotator cuff syndrome and bursitis.​

There are three main types of TOS, named according to the cause of the symptoms; however because TOS is not well understood, there is still much controversy among physicians over these classifications.

Vascular - Rare and usually involves compression of the subclavian artery or vein. 

Neurogenic - Involves compression of the brachial plexus. The majority of TOS cases are neurogenic.  

Nonspecific-type - Involves unexplained pain in the cervical region, scapular region, and arm. Symptoms typically begin after a traumatic event.

What Causes TOS

• Physical trauma or injury
• Repetitive injuries from job or sports related activities
• vigorous overhead arm activity
• Weight gain
• Anatomical abnormalities - such as having an extra rib
• Pregnancy

Signs and Symptoms
Depending on which structures are compressed, symptoms can vary. 

Vascular:

• Bluish color in hand
• Arm pain and swelling
• Lack of color in one or more of your fingers or your entire hand
• Weak or no pulse in the affected arm
• Cold fingers, hands or arms
• Numbness or tingling in your fingers
• Weakness of arm or neck
• Throbbing lump near your collarbone

Neurogenic:

• Muscle wasting in the fleshy base of your thumb.
• Numbness or tingling in your arm or fingers
• Pain or aches in your neck, shoulder or hand
• Weakening grip

What You Can Do To Relieve The Pain

Massage Therapy

Massage is effective if the impingement is due to muscle tightness or spasm. Massage helps by relaxing the muscles, increasing circulation and reducing inflammation. If symptoms do not diminish with massage, impingement may be due to another cause and you should see your doctor. 

Stretches and Exercises

Ice or Heat

Using either ice or heat on the collar bone, shoulder blades and armpits and give some relief.  Generally rule is 20 minutes on, 20 minutes off. 

Physical Therapy

Manual (hands-on) therapy may be applied to manipulate or mobilize the nerves of the arm to help reduce symptoms, such as pain and numbness/tingling. 

Acupuncture

According to Traditional Chinese Medicine, symptoms of Thoracic Outlet Syndrome such as pain, tingling and numbness is seen as a "stagnation of Qi and Xue”. Specific placement of single use, hair-thin needles can help release this stagnation, promoting smooth flow and inhibiting pain.

Improve Your Posture

Use a Tennis Ball

When To See A Doctor
See your doctor if you are consistently experiencing any of the signs and symptoms of thoracic outlet syndrome.