Thoracic Outlet Syndrome (TOS) has symptoms of pain, paraesthesia, weakness and discomfort in the upper limbs. The pain or discomfort is aggravated by lifting up the arms and movements of the head and neck. This condition occurs when the blood vessels and/or nerve complex are compressed, irritated or injured in the area of your neck, collarbone, upper chest area and the first rib, which then causes numbness and pain in the upper limbs.

What are the causes of Thoracic Outlet Syndrome?

TOS affects all ages and genders, but is more common in those that have overhead repetitive movements. There are various causes that can contribute to TOS which are listed below:

  1. Bone pathology in the area of the first rib or collar bone
  2. Soft tissue changes in the muscles and joints
  3. Traumatic injury
  4. Lung tumour
  5. Postural & Occupational stressors
  6. Pregnancy

What are the signs and symptoms of TOS?

In thoracic outlet syndrome there can be compression of the vascular structures (vascular TOS), compression of the neural structures (neurogenic TOS) and non-specific type TOS. The symptoms vary according to which structures are being compressed but have the following symptoms:

  • Ischemic changes in the fingers
  • Sensations of pain, coldness, colour loss and pulse loss in the fingers
  • Swelling and cyanosis in the hands and fingers
  • Sensations of numbness, muscles weakness and atrophy in the hands and fingers
  • Possible loss of fine motor skills
  • Loss of grip strength

How is TOS diagnosed?

Diagnosing TOS can be quite difficult as the symptoms vary vastly within the population. The diagnosis is mainly done from a thorough clinical history and examination by your doctor and physiotherapist.

The medical professional may send you for X-rays, MRI, CT scan or any other special tests that they see fit, but it is not common to do so.

What are the treatment options?

Physiotherapy –

Medical/Surgical option –

Surgery is only recommended if conservative treatment has not been successful, if there is no relief from your symptoms and/or if there is risk of neurological damage. The success after surgery is also not guaranteed and symptoms may re-occur.

Lifestyle tips

  • Avoid carrying heavy bags on one shoulder.
  • Become aware of your posture.
  • Take frequent breaks at work, stretch and change your set up if necessary.


This article was prepared by Rikki Malherbe, one of the physiotherapists at our Paulshof Practice. You can contact her for a discussion on this complex syndrome by completing the quick online form.


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  3. Clinical Sports Medicine – 5th Edition. Thoracic outlet syndrome.
  4. – Thoracic Outlet Syndrome.