Musculoskeletal

Thoracic Outlet Syndrome (TOS)

Thoracic outlet syndrome (TOS) is a group of disorders that occur when the blood vessels or nerves in the space between the collarbone and first rib (the thoracic outlet) become compressed. This can cause pain in the shoulders and neck and numbness in the fingers. There are three types: neurogenic (most common), venous, and arterial TOS.

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Symptoms

4

Causes

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Treatments

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Prevention

Condition Overview

Understand key symptoms, causes, diagnosis options, and treatment pathways for Thoracic Outlet Syndrome (TOS). This overview is intended for patient awareness and should be followed by specialist consultation.

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Symptoms

  • Numbness or tingling in the fingers (especially ulnar nerve distribution)
  • Neck, shoulder, and arm pain
  • Weak grip
  • Swelling of the arm (venous TOS)
  • Arm that changes color (venous/arterial TOS)
  • Blood clots in upper extremity veins (Paget-Schroetter syndrome)

Causes

  • Anatomical defects (cervical rib, tight scalene muscles)
  • Poor posture
  • Repetitive overhead activities
  • Trauma (whiplash, fall)

Diagnosis

  • Physical examination (provocative tests: Adson, Roos)
  • Nerve conduction studies
  • Imaging: X-ray, MRI, CT angiography
  • Doppler ultrasound

Treatment

  • Physical therapy (posture correction, scalene muscle stretching)
  • NSAIDs
  • Botulinum toxin injections into scalene muscles
  • Surgery (rib resection, scalenectomy) for refractory or vascular TOS

Risk Factors

  • Cervical rib
  • Poor posture
  • Repetitive overhead activities
  • Trauma to the neck or shoulder
  • Female sex

Prevention

  • Maintain good posture
  • Strengthen shoulder and neck muscles
  • Ergonomic workstation setup

Prevalence

Neurogenic TOS affects approximately 3–80 per 1,000 people; true prevalence uncertain.