Thoracic Outlet Syndrome: Causes, Symptoms And Treatment

In this video, Brittany Bankson, DC discusses the common causes and symptoms of Thoracic Outlet Syndrome, a condition that causes shoulder, neck, and arm pain. She also touches on how traditional healthcare usually treats TOS and how Airrosti handles it a little differently.


The thoracic outlet is a small space that lies between your lower neck and the front of your shoulder, where nerves, arteries, and blood vessels travel to reach the arms. When these parts become compressed or injured in the thoracic outlet, a disorder known as thoracic outlet syndrome (TOS) occurs. There are three main types of thoracic outlet syndrome, and all three forms cause pain in the shoulder and neck. Many people with TOS also experience pain radiating down the arm into the hand. If this disorder is left untreated, the pressure on the cardiovascular system caused by thoracic outlet syndrome can lead to blood clots, muscle atrophy, and even permanent nerve damage.


Although it’s a rare condition, thoracic outlet syndrome is typically caused by:
· poor posture
· obesity
· repetitive arm and shoulder movements
· anatomical abnormalities
Those who play sports or have a job that requires repetitive overhand movements are more likely to suffer from TOS. You may also be at a higher risk of developing TOS if you’re between 20 and 40 years old, pregnant, or if you’ve suffered from a traumatic injury to the neck or back.
Some TOS cases are caused by a congenital variation, such as having an extra rib. These anatomical abnormalities can limit the space in the thoracic outlet and put pressure on your nerves and arteries.


The three main types of thoracic outlet syndrome are neurogenic, venous, and arterial TOS. Each type of TOS is slightly different, with causes and treatment options varying slightly for each.

Neurogenic thoracic outlet syndrome

This is the most common form of TOS. It happens when the brachial plexus nerves are compressed. Many patients respond well to conservative treatment. Symptoms of neurogenic TOS include:

    • pain in the neck, shoulder, and arm
    • headaches
    • numbness, tingling, or weakness in the arm or hand
    • arm or shoulder pain when reaching, lifting, throwing, or catching objects
    • hand coldness and intolerance to cold

Venous thoracic outlet syndrome

This condition develops when the subclavian vein is compressed between the clavicle and first rib. A blood clot will form in the compressed vein, leading to arm swelling, discoloration, numbness, and pain. This syndrome is also known as Paget-Schroetter disease. It’s not as common as neurogenic TOS, but it is one of the most common vascular disorders in competitive athletes and should be treated swiftly to avoid worsening symptoms.

Arterial thoracic outlet syndrome

This is the rarest form of TOS, affecting only about 5% of all patients with TOS. Arterial TOS happens when the subclavian artery is compressed. This can lead to aneurysms and blood clotting. Symptoms of arterial TOS include:

    • hand pain
    • coldness, paleness, and tingling sensations in the hand
    • chronic arm weakness and cramping when in use

These three types of thoracic outlet syndrome may have similar symptoms, but getting the proper diagnosis can lead to more treatment recommendations and faster recovery.


Because the symptoms of thoracic outlet syndrome can mimic other health conditions, it is crucial that your doctor develops a differential diagnosis to determine the true source of your pain. Your doctor may order various imaging and nerve study tests to help determine the cause of pain and rule out other conditions.

Most cases of thoracic outlet syndrome can be resolved with conservative treatment. Initially your doctor may recommend physical and occupational therapy to fix posture issues and rebuild weakened muscles.

Over-the-counter pain medications and muscle relaxants may be prescribed for pain relief, while thrombolytic and anticoagulant medications might be prescribed to help dissolve and prevent blood clots.

Surgery is often recommended if an anatomical abnormality is the cause or if conservative treatments don’t resolve the condition. Physical therapy may be used before and after surgery to rebuild muscles and facilitate recovery.

Although physical therapy can be an effective form of conservative treatment for many, the strengthening and recovery process can take months, and the costs can quickly add up. Surgery requires extensive recovery time, rendering you unable to do many of the activities you love. It can also be too costly, both financially and in health, with high costs and risks for potential complications.


An accurate diagnosis is critical to receiving the appropriate treatment while avoiding unnecessary costs. At Airrosti, our providers can help diagnose and treat the root cause of your pain and can fully resolve most cases in as few as three visits (based on patient-reported outcomes). Our providers can significantly reduce recovery time, increase range of motion, and keep patients active during and after treatment.

Thoracic outlet syndrome can take a toll on your health and well-being, and the symptoms can be painful and difficult to manage. If you’re experiencing shoulder or arm pain, or suspect you may have TOS, call us at (800) 404-6050 to schedule a risk-free consultation with Airrosti today.

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