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Home > Health & Wellness > Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

The term Thoracic Outlet describes the left and right hollows either side of the throat behind the collar bone.

A lot goes on in these hollows as you can see there are major arteries nerves and veins leaving the neck to supply the arm, hand and fingers.

Thoracic Outlet Syndrome is a term given to compression on any of these structures which can cause a lot of unusual symptoms from the neck and armpit right down to the hand and fingers. These symptoms may include anomalies of the nervous system such as pins and needles, numbness or sensations of hot or cold in the extremities of the arm. At it’s worst muscle wasting of the hand can be seen particularly in the thenar eminence which is the term used to describe the fleshy muscle at the base of the thumb.

TOS causing problems to the vein can also cause tingling, pain or numbness in the hand which may also look whitened and be cool to the touch.

If the artery is compromised by TOS, again there will be a chillyness in the hand and fingers and there may be discolouration of the skin caused by a lack of oxygen to the area as the circulation is impaired. Once again there may also be pins and needles or tingling and a deep ache in the hand.

The Thoracic Outlet is boardered by neck muscles (Scalene and Sternocleidomastoid) and bone (collar bone, first thoracic vertebra and the first pair of ribs.)

 Any change to these structures may alter the shape of the Thoracic Outlet and so cause pressure on the nerves and circulatory vessels.

Causes of TOS


Fractures to the clavicle (collar bone) acromio-clavicular joint and shoulder may cause an alteration in the volume of the thoracic outlet.

Repeated Stress

Heavy repetitious work with the upper limbs such as labouring, weight lifting or forceful impact through the shoulders can result in tension in the neck and shoulder muscles thus reducing the space within the thoracic outlet.

Some sports can also contribute such as rugby due to the contact and racquet sports due to the repetition combined with impact.


The first rib is a short and fairly thick bone in comparison to the lower ribs. It gives attachment to the scalene muscles of the neck and the first attachment of serratus anterior which is at the top of the chest wall. This rib also gives attachment to the top of the lung. Occasionally this rib may be extra long which can then intrude into the thoracic outlet.

Another congenital anomaly is the Cervical Rib. This is rarer cause of TOS.

Our ribs begin in the thoracic section of the spine  (at T1) however some people have an extra rib arising from the last cervical section of the spine, from C7.

This “extra rib can encroach upon the thoracic outlet space causing the above mentioned symptoms.

Pathological Causes

Upper lung tumours can put pressure on the nerve and vascular tubing within the thoracic outlet.


In the first instance an X Ray will be required to check for extra ribs or elongated transverse processes in the cervical spine.

Appointments with the Neurologist and Vascular Specialist may also be required to determine the cause of any compression on nerves, veins or arteries. Thoracic Outlet Syndrome is often difficult to diagnose as there are many other conditions which mimic this syndrome, however once diagnosed there is a good prognosis for recovery.


Treatment will of course depend upon the cause. If impingement upon a vein, nerve or artery is deemed to be the cause, then surgery may be required to relieve the pressure allowing improved vascular flow or nerve conduction.


Tracey Evans MCSP SRP COFIB Col 220 Physiotherapist

The Physiotherapy Centre

+34 609 353 805

Photo: @Mayo Foundation for Medical Eduction & Research

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