Thoracic outlet syndrome (TOS) is a condition that can be easily misunderstood or overlooked due to its varied symptoms. It can lead to persistent discomfort, numbness, and weakness in the arms and hands if left untreated. While it affects a relatively small portion of the population, it can have a significant impact on daily life, particularly for those with certain postural habits, repetitive strain, or previous injuries.
This article will explore how to identify thoracic outlet syndrome, thoracic outlet syndrome symptoms, tests for thoracic outlet syndrome and the treatments you can get.
What is Thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a group of disorders that occur when the nerves or blood vessels in your lower neck and upper chest are compressed. The term “Thoracic outlet” refers to the opening between your neck and your chest. This opening is a channel for many important structures including your brachia plexus (a nerve that crosses from your neck to your armpit), subclavian artery and subclavian vein.
Types of Thoracic outlet syndrome
TOS is typically put into three types, depending on which structure is being compressed. This is between nerves, veins and arteries. Each type presents differently.
Neurogenic Thoracic outlet Syndrome (nTOS)
This is the most common form of TOS, accounting for around 8% of the population. It occurs when the brachial plexus, a network of nerves that runs from your neck through the upper chest, is compressed. Neurogenic TOS is often diagnosed in people in their 30s, and the most common triggers include repetitive strain injuries (such as those from sports or manual work) or trauma to the neck, like whiplash.
Venous Thoracic outlet syndrome (vTOS)
Venous TOS involves compression of the subclavian vein, which can lead to swelling, pain, and discolouration in the affected arm, usually the dominant one. This type is more common in males, particularly those in their 20s and 30s, and often arises after vigorous or repetitive arm activity.
Arterial Thoracic outlet syndrome (aTOS)
Arterial TOS is the rarest form, making up roughly 1% of TOS cases, but it’s also the leading cause of acute upper limb blood clots in people under 40. It involves compression of the subclavian artery and is usually due to congenital structural differences, such as having a cervical rib.
Causes of Thoracic outlet syndrome
TOS happens when the nerves or blood vessels in your upper chest become squashed. Things that can lead to this happening include:
- Poor posture
- An injury to the chest, neck, or ribs
- Gaining a lot of muscle (e.g. if you’re a bodybuilder)
- Being born with an extra rib (known as cervical rib)
Thoracic outlet syndrome symptoms
Recognising the signs of thoracic outlet syndrome can be tricky, as the symptoms often overlap with other conditions. However, knowing what to look out for can help you seek the right support sooner and prevent the issue from worsening. Thoracic outlet syndrome symptoms affect your upper body typically one side and include:
- Numbness
- Weakness
- Pins and needles
- Pain (this may worsen when you lift your arms)
- Swelling or heaviness
- Skin going pale or blue
- Skin that feels cold to the touch
Thoracic outlet syndrome tests
Healthcare providers diagnose TOS by performing a thoracic outlet syndrome test. Part of this exam will include your provider asking you to do movement based tests. This will include an upper limb tension test and elevated arm stress test. During this, you will do things such as lifting your arms, tilting your head and clenching your fists. From this your provider will see which movements cause pain or other thoracic outlet syndrome symptoms.
Thoracic outlet syndrome treatments
Treating thoracic outlet syndrome depends on the type and severity of the condition. In most cases, conservative, no -surgical approaches are great in managing symptoms and improving quality of life. Thoracic outlet syndrome treatments include:
Physiotherapy and osteopathy
One of the most effective treatments for TOS is manual therapy. Physiotherapy can help by addressing postural imbalances, improving neck and shoulders, and strengthening the surrounding muscles to relieve pressure on the nerves and blood vessels. Osteopathy can help by using hands-on techniques to release muscle tension, improve circulation and restore natural alignment, supporting the body’s own healing process.
Medications
Anti-inflammatory medications such as ibuprofen may be used to manage pain and reduce swelling. In some cases, your doctor might recommend corticosteroid injections to target inflammation.
Lifestyle adjustments
Patients are often advised to avoid activities that aggravate symptoms, especially repetitive overhead movements or carrying heavy loads. Postural training and ergonomic changes at work or during exercise can make a significant difference.
Surgical intervention
If thoracic outlet syndrome symptoms don’t improve with conservative care, or if there’s significant nerve or blood vessel compression, surgery may be considered. This typically involves removing part of a rib or releasing tight muscles to create more space in the thoracic outlet. However, surgery is usually a last resort.
How Carl Todd Clinics can help
At Carl Todd Clinics, our experienced team of physiotherapists and osteopaths are skilled in treating thoracic outlet syndrome with tailored, hands-on care. We take a whole-body approach to treatment, working to reduce nerve and vascular compression, improve your posture and mobility, and relieve discomfort at the source.
Whether you’re an athlete or dealing with the effects of repetitive strain or postural stress, we’ll create a personalised treatment plan that helps you move better and feel better. Ready to take the next step? Get in touch with our friendly team today to book an appointment or find out how we can support your recovery.
