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Thoracic Outlet Syndrome (TOS)

Updated: Nov 1, 2023

Thoracic outlet syndrome (TOS) is a condition where nerves of the brachial plexus, or the subclavian artery, become compressed by certain muscles and can cause pain in the shoulders, arms, or neck.

It also includes symptoms of numbness, coldness, weakness, or tingling into hands or fingers. The muscles that are the culprits of this are the anterior and medial scalenes, and pectoralis minor.

What is Thoracic Outlet Syndrome or TOS?

Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause shoulder and neck pain and numbness in your fingers. The brachial plexus is a network of nerves in the axillary area of the shoulder that carry movement and sensory signals from the spinal cord to the arms and hands.

What are the common causes of TOS (Thoracic Outlet Syndrome)?

Common causes of TOS include trauma, repetitive injury, pregnancy, poor posture, and anatomical defects, such as having a cervical rib. Thoracic Outlet Syndrome affects people of all ages and gender. The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, and volleyball for example. Neurogenic TOS is the most common form of the disorder (95 percent of people with TOS have this form of the disorder) and generally affects middle-aged women. Recent studies have shown that, in general, TOS is more common in women than men, particularly among those with poor muscular development, poor posture or both.

What are common symptoms to look for in TOS?

  • Neurogenic (neurologic) thoracic outlet syndrome: This most common type of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand.

  • Venous thoracic outlet syndrome: This type of thoracic outlet syndrome occurs when one or more of the veins under the collarbone (clavicle) are compressed, resulting in blood clots.

  • Arterial thoracic outlet syndrome: This is the least common type of TOS. It occurs when one of the arteries under the collarbone is compressed, resulting in bulging of the artery, also known as an aneurysm.

Symptoms of Neurogenic Thoracic Outlet Syndrome:

  • Pain or weakness in the shoulder and arm

  • Tingling or discomfort in the fingers

  • Arm that tires quickly

  • Atrophy — shrinking and weakness — of the pad of the thumb, the muscle of the palm that leads to the thumb; this is quite rare

Symptoms of Venous Thoracic Outlet Syndrome:

  • Edema (swelling) of the arm, hand or fingers

  • Blueness of the hand and arm

  • Painful tingling in the hand and arm

  • Very prominent veins in the shoulder, neck and hand

Symptoms of Arterial Thoracic Outlet Syndrome:

  • Cold and pale hand

  • Pain in the hand and arm, especially during overhead motions of the arm

  • Embolism (blockage) of an artery in the hand or arm

  • Aneurysm of the subclavian artery

How do you diagnose and treat Thoracic Outlet Syndrome?

To diagnose your condition, your doctor will perform a complete physical exam and will review the results of previous diagnostic tests. As chiropractors, we have specific orthopedic exams to test the area of entrapment and what region or muscle is causing the problem. We treat the affected muscles by providing muscle work and stretches. We also prescribe home care which involves stretching affected muscles and alternating application of ice and heat. We also address posture and ergonomics. In some cases, a thorough evaluation by a skilled neurologist may be recommended to rule out cervical spine disease or other neurological conditions that may be mimicking or causing your symptoms.

What are some lifestyle changes I can make if I have TOS?

  • Maintain good posture

  • Take frequent breaks at work to move and stretch

  • Maintain a healthy weight

  • Create a work area that allows you to keep good posture and doesn't make symptoms worse

  • Gently massage your shoulders and thoracic outlet

  • Apply a heating pad to the area

  • Practice relaxation exercises such as deep breathing, meditation and stretching

In Conclusion

Symptoms can overlap with common orthopedic and neurological diagnoses, such as carpal tunnel syndrome, ulnar nerve compression/injury, shoulder problems and cervical spine problems. At ANH Wellness,, we have a personalized approach to managing patients with TOS. Make an appointment today to get the help you need!

ANH Wellness can address these specific problems in the body. Our skilled providers can aid in eliminating pain at the source through manual treatment followed by specific strengthening and stretching exercises to help prevent injury while restoring strength and mobility!

By: Dr. Ary Laudeman

Chiropractor at ANH Wellness

Disclaimer: "The information including but not limited to text, graphics, images, and other material contained on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment."

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