Thoracic Outlet Syndrome
Thoracic Outlet Syndrome: Causes, Symptoms, and Relief
Are you dealing with numbness, tingling, or aching in your arms, shoulders, or hands—especially after working at a desk, exercising, or sleeping? You may be experiencing Thoracic Outlet Syndrome (TOS)—a common yet often overlooked condition we treat right here at Radius Physical + Sports Rehab.
What Is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (TOS) occurs when nerves or blood vessels become compressed between your neck, collarbone, and upper chest. These vital structures pass through a small space known as the thoracic outlet, and when that space narrows due to tight muscles, poor posture, or anatomical differences, it can cause pain and a range of uncomfortable symptoms.
TOS is more common than most people realize, especially in:
- Desk workers with forward head posture
- Athletes or active adults who use their arms overhead
- Women, who are statistically more likely to experience TOS
- People with prior neck or shoulder injuries
Common Symptoms of TOS
If you have Thoracic Outlet Syndrome, you might notice symptoms such as:
- Numbness, tingling, or “pins and needles” in the arms or fingers
- Weakness or heaviness in the upper extremity
- Pain or tightness in the neck, collarbone, shoulder, or upper chest
- Worsening symptoms when lifting arms, typing, or lying down
Patients often report that sleep, overhead movements, or long hours at the computer make things worse. Sound familiar? You're not alone—and we can help.
What Causes Thoracic Outlet Syndrome?
TOS can develop from several causes:
- Muscle tightness, especially in the scalenes (sides of the neck) and pectoralis minor (front of the chest)
- Poor posture, including forward head and rounded shoulders
- Repetitive overhead activity
- Cervical ribs or elongated bones (anatomical variations)
- Previous trauma or injury to the neck and shoulder area
Because TOS has multiple potential causes, it’s important to receive a thorough assessment to determine your unique contributing factors.
How Radius Helps You Recover from TOS
At Radius Physical + Sports Rehab, our musculoskeletal providers are trained to accurately assess and treat Thoracic Outlet Syndrome through conservative, non-invasive methods. Most patients do not need surgery and respond well to personalized rehab.
Your care plan may include:
✅ Targeted manual therapy to reduce muscular tension
✅ Posture correction strategies to relieve compression
✅ Custom stretches and exercisesto open the thoracic outlet
✅ Strengthening for surrounding muscles to improve support
✅ Lifestyle modifications and ergonomic advice
We also work closely with you to identify and modify aggravating activities, whether that’s typing at your desk, reaching overhead, or how you sleep.
Why Choose Radius for TOS Treatment?
Our team treats every patient like family—and we focus on identifying and resolving the root cause of your pain.
Whether you’re an athlete, a busy parent, or a professional tied to your desk, our goal is to help you:
- Reduce pain
- Improve mobility
- Restore strength
- Prevent future flare-ups
Don’t Let TOS Limit Your Life
If you’re struggling with upper body numbness, pain, or discomfort that worsens with posture or activity, you don’t have to wait for it to get worse. Conservative care works—and we’re here to help.
Frequently Asked Questions
Common questions about thoracic outlet syndrome.
What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a group of disorders caused by compression of the nerves or blood vessels that pass through the thoracic outlet, the space between the first rib, the scalene muscles, and the collarbone in the lower neck and upper chest. Depending on which structures are squeezed, it is classified as neurogenic (compressing the brachial plexus nerves) or vascular, involving the subclavian vein or artery.
What are the types of thoracic outlet syndrome?
Thoracic outlet syndrome has three main types. Neurogenic TOS, compression of the brachial plexus nerves, is by far the most common, accounting for over 90% of cases. Venous TOS is compression of the subclavian vein, and arterial TOS is compression of the subclavian artery. Arterial TOS is the rarest, representing about 1% of cases. The neurogenic and vascular forms cause different symptoms, so distinguishing them matters for care.
What does thoracic outlet syndrome feel like?
Neurogenic thoracic outlet syndrome, the most common form, typically causes pain, numbness, and tingling in the hand, arm, shoulder, and often the neck, along with a vague aching. Symptoms usually worsen when the involved arm and hand are raised over the head. Hand weakness, clumsiness, cold intolerance, and, over time, wasting of the small muscles of the hand can also develop. Some people also report headaches.
What causes thoracic outlet syndrome, and who is at risk?
Thoracic outlet syndrome develops when the thoracic outlet is narrowed or the nerves and vessels within it are irritated. Common contributors include past trauma or neck injury, chronic poor posture such as rounded shoulders and forward head carriage, and repetitive or overhead motions. An extra rib arising from the seventh cervical vertebra, called a cervical rib, is a recognized cause. TOS is more common in females and in people with poor muscle development or posture.
How is thoracic outlet syndrome diagnosed?
Diagnosis of thoracic outlet syndrome begins with a thorough health history and physical exam. Clinicians assess symmetry and range of motion of both arms and use movement-based provocation tests, such as the Adson maneuver and the Roos test, that position the arm to reproduce symptoms or change the pulse. Imaging often starts with a chest or cervical spine x-ray, and testing may include Doppler ultrasound or nerve conduction velocity studies.
How is thoracic outlet syndrome treated without surgery?
Physical therapy is a mainstay first-line treatment for thoracic outlet syndrome. It aims to strengthen the muscles around the thoracic outlet to relieve pressure on the affected structures, and typically includes patient education, range-of-motion and muscle-strengthening exercises, manual therapy, pain management, and functional training. Postural correction commonly helps, and attention to sleeping position matters, since sleeping with the arms overhead should be avoided. In about 90% of cases, symptoms resolve with conservative therapy.
When should I see a clinician about thoracic outlet syndrome, and what are the warning signs?
If you have symptoms of thoracic outlet syndrome, see a healthcare provider for a diagnosis. Some signs point to the vascular forms and need prompt attention: arm swelling, aching, or a blue-to-purple discoloration can indicate venous TOS, while a cold, pale, or painful arm with numbness can indicate arterial TOS. These vascular types can cause blood clots. Seek emergency care right away for symptoms that could signal a pulmonary embolism, heart attack, or stroke.
The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.
