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Thoracic Outlet Syndrome (TOS): Causes, Symptoms, Treatment

Dr. Aaishah Riaz

3 min read

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Thoracic Outlet Syndrome (TOS) is a condition characterized by the compression of nerves or blood vessels in the thoracic outlet, an anatomical region between the neck and shoulder. This syndrome may cause a host of symptoms, that include but aren’t limited to, numbness, tingling, and weakness as well as pain in the upper extremities.

Below we will discuss Thoracic Outlet Syndrome in detail, including its symptoms, causes, diagnosis, treatment options. We will also be analyzing the role of thoracic surgery in the management of Thoracic Outlet Syndrome (TOS).

What Are The Causes of Thoracic Outlet Syndrome?

Following are the common causes of Thoracic Outlet Syndrome:

  1. Anatomical Variations: Certain individuals are born with anatomical variations, such as an abnormally tight space between the collarbone and the first rib. This can increase the risk of nerve and vessel compression.
  2. Trauma: Certain injuries can cause damage to the structures in the thoracic outlet, leading to TOS. These can include injuries from falls, and car accidents, etc.
  3. Repetitive Movements: Activities that involve repetitive arm movements, such as typing or playing certain sports, may lead to the development of TOS.
  4. Poor Posture: Having or maintaining a poor or abnormal posture over a long period of time is detrimental to your health. For instance, having a posture with your shoulders slumped forward may lead to muscle imbalances and compression of the thoracic outlet leading to TOS.
  5. Cervical Rib: A cervical rib is an extra rib that originates from the seventh cervical vertebra. According to research, 1 out of 10 people with a cervical rib develop thoracic outlet syndrome.

What Are The Symptoms Of Thoracic Outlet Syndrome?

Following are the common symptoms of Thoracic Outlet Syndrome. Symptoms may vary from person to person:

  1. Discomfort: and Pain TOS-affected individuals can experience pain in the neck, shoulder, and upper arm. The intensity of this pain can range from dull, achy, or sharp. It may also radiate down the arm to the hand and fingers.
  2. Tingling and Numbness: Compressed or irritated nerves in the thoracic outlet can lead to numbness, tingling sensation in the arm that is affected.
  3. Muscle Weakness: Weakened grip strength and muscle fatigue in the affected arm are common symptoms of TOS. This can affect everyday activities such as lifting objects or performing fine motor tasks.
  4. Discoloration and Swelling: Some individuals may experience swelling and discoloration in the affected arm due to compromised blood flow due to TOS.

How Is Thoracic Outlet Syndrome Diagnosed?

It can be challenging to diagnose TOS due to its vast array of symptoms and the need to rule out other conditions. A comprehensive evaluation by a healthcare professional or thoracic surgeon is imperative to ascertain the underlying cause of the condition. TOS may be diagnosed in the following ways.

  1. Physical Examination: A thorough examination of the affected arm’s posture, range of motion, and strength can provide key information.
  2. X-Ray Thoracic Inlet: An X-ray of the thoracic inlet can be conducted to diagnose potential rib abnormalities, fractures, and structural issues that can contribute to conditions such as TOS.
  3. MRI Neck: An MRI of the neck can also be helpful for visualize the ligaments, tissues, and blood vessels in the neck to help determine the probable cause of TOS.
  4. EMG and NCS: Electromyography (EMG) and nerve conduction studies (NCS) can assess nerve function and identify areas of dysfunction.
  5. Arterial & Venous Doppler Studies: Arterial & Venous Doppler Studies are tests that can help diagnose vascular compression or obstruction within the thoracic outlet.

How is Thoracic Outlet Syndrome Treated?

The treatment for TOS can differ based on the underlying cause and severity of symptoms. Treatment options can include:

  1. Physical Therapy: Gentle exercises and stretches can help improve posture, strengthen muscles, and relieve compression in the thoracic outlet.
  2. Pain Management: Over-the-counter pain relievers, physical modalities like heat or ice, and nerve pain medications may be recommended to manage discomfort.
  3. Thoracic Surgery for TOS: In cases where conservative treatments fail to provide relief or when there is a structural obstruction causing the syndrome, thoracic surgery may be considered. Thoracic outlet decompression surgery aims to alleviate the compression of nerves and blood vessels by removing or modifying the obstructing structures. During the procedure, the surgeon may remove a portion of the first rib, release tight muscles or ligaments, and address any other anatomical anomalies contributing to TOS. For specific cases in which TOS is caused due to a cervical rib, a thoracic surgeon may perform a cervical rib and first rib excision surgery. This surgical procedure can help reduce the symptoms associated with TOS by relieving the compression of nerves and blood vessels in the thoracic outlet.
  4. Lifestyle Modifications: Individuals with TOS can benefit from ergonomic adjustments, avoiding repetitive movements, and practicing good posture to prevent symptom recurrence.


Thoracic Outlet Syndrome is a complex condition and one that involves a comprehensive diagnosis and treatment approach. Early diagnosis of symptoms, and proper medical intervention, including thoracic surgery when required, can significantly improve the quality of life for individuals affected by TOS.

If you suspect you may be experiencing symptoms of TOS, it is recommended to consult a thoracic surgeon for its appropriate treatment. You can book an appointment with a thoracic surgeon in Islamabad, Karachi, Lahore or other cities in Pakistan through oladoc.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Aaishah Riaz
Dr. Aaishah Riaz - Author Dr. Aaishah Riaz is a Thoracic Surgeon with 5 years of experience currently practicing at PAF Hospital (Islamabad), Islamabad. You can book an appointment with Dr. Aaishah Riaz through oladoc.com or by calling at 0518151800.

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