What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) describes a group of disorders that occur when a person’s blood vessels or nerves become compressed between their collar bone and first rib. A person experiences symptoms secondary to the neurovascular compression. This syndrome can occur due to compression and damage to a person’s brachial plexus, which is a large group of nerves coming from the neck, or due to compression of a person’s vascular supply, or a combination of both.  People between 20-40 years of age and women are at a greater risk of experiencing TOS.

What commonly causes Thoracic outlet syndrome?

Common causes of this condition could be due to physical trauma, presence of a cervical rib, an abnormal first rib, a person’s posture, hypertrophy (increased muscle) or spasm of the scalene musculature in the neck, and/or due to repetitive injuries.

What are common symptoms a person may have?

There are 2 common types of TOS, therefore a person may present with different symptoms depending on what structures are being compressed.

  1. Neurogenic (neurological) TOS: This is the most common type of TOS, and is classified by compression of the brachial plexus.
  2. Vascular TOS: When one of the veins or arteries under the collar bone are compressed.

Neurological symptoms presentation:

  • Muscle wasting in the arm, forearm, or hand
  • Numbness/tingling in the arm or fingers
  • Pain in the neck, shoulder or hand
  • Weakening grip

Vascular symptoms presentation:

  • Hand discoloration (bluish)
  • Edema (swelling)
  • Weak or no pulse in the arm
  • Cold fingers, hands or arms
  • Numbness/tingling in the fingers
  • Weakness of the arm or neck
  • Blood clot in the veins or arteries in the upper area of the body


What can physical therapy do?

At A. Fox Physical Therapy, PC, your first appointment will be with a Doctor of Physical Therapy, where we will discuss your history and assist in the process of identifying the probable cause of your TOS symptoms. Treatment will then be tailored at posture modification, breathing patterns, positioning during sleep or while at work, and gentle stretching. There will also be a focus on pain management and strengthening the shoulder stabilizer musculature.

If you have further questions regarding how physical therapy can play a role in decreasing pain and improving your function, please call or email us. A DPT level PT will return your inquiry within 48 hours.