Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a condition that occur when blood vessels, arteries or veins in the space between your collarbone and your first rib (thoracic outlet) are compressed. There are three main types of this syndrome – neurogenic, venous and arterial. The neurogenic type is the most common type and is caused by compression of components of brachial plexus nerves. Arterial type of Thoracic Outlet Syndrome is rare and is caused due to compression of subclavian artery. Venous type is extremely rare type of TOS and is caused due to compression of subclavian vein.

Symptoms of Thoracic Outlet Syndrome

Symptoms may vary depending on which nerves or blood vessels are compressed. However, common symptoms include neck and shoulder pain, arm pain, numbness and tingling of the fingers and impaired circulation to the extremities. Compressed blood vessels cause swelling, redness and weakness of the arms.

These symptoms may worsen when the thoracic outlet is narrowed in certain body positions like when the arm is raised overhead.

TOS can also lead to eye problems including vision loss because of vertebral artery compression. Some other complications that can be caused by Thoracic Outlet Syndrome are Ischemic ulcers of the fingers, Gangrene, Pulmonary embolism and neurogenic complications such as permanent nerve damage.



Congenital problem like extra first rib (cervical rib)
Certain trauma like a car accident
Drooping Shoulders
Old fracture of the clavicle (collarbone)
Bony and soft tissue abnormalities
Unknown causes

It is more common in women and occurs commonly between 20 and 50 years of age.
Other risk factors include

Sleep disorders
Tumors that press on nerves
Repetitive arm and shoulder movements
Repetitive injuries from carrying heavy shoulder loads
Injury to the neck or back
Poor posture
Weight lifting



Treatment for Thoracic Outlet Syndrome

Treatment depends on what caused your Thoracic Outlet Syndrome and generally does not include surgery

Non-steroidal anti-inflammatory drugs are given to reduce the swelling and pain so that patient can be put on physical exercises

Physical Therapy is mainly recommended to strengthen the muscles surrounding the shoulder. Some postural exercises are also taught to improve the overall posture which helps reduce pressure on the nerves and blood vessels.

Doctor will advise you to stop certain strenuous activities and recommend certain changes in the lifestyle.


Surgery is advised if all non-surgical treatments fail to relieve the symptom. It is estimated that only 10 to 20% of patients with TOS need surgical treatment. It is often microsurgery which is performed to remove portion of abnormal first rib or to release muscles that joint the neck and chest, or to reroute blood vessels around the thoracic outlet.

Physical therapy is often used before and after the surgery to improve recovery.


Prevention of Thoracic Outlet Syndrome

Practicing proper posture while sitting and standing
Taking breaks at work
Maintaining a healthy weight
Not sleeping with arms above your chest
Performing strengthening exercises
Avoiding lifting heavy objects

For questions related to Thoracic Outlet Syndrome, you can write to

© Copyright 2021 Bangalore Shoulder Institute