Thoracic Outlet Syndrome
Updated: 18 hours ago
Thoracic outlet syndrome (TOS) involves compression of nerves or blood vessels as they pass between the neck and upper chest towards the arm. It can cause arm or hand symptoms, but similar symptoms can have other causes. Medical assessment helps establish the diagnosis and whether nerves, blood vessels or both may be affected.
Symptoms of Thoracic Outlet Syndrome
Possible nerve-related symptoms include:
pins and needles
sharp or shooting pain
numbness
Symptoms may vary with activity or arm position. Some people also notice weakness, swelling, coldness or changes in the colour of the arm or hand. These symptoms are not enough to diagnose TOS by themselves.
Assessment combines your history and examination and may require scans or other tests. Changes in the wrist pulse during an arm-position test cannot reliably confirm or exclude TOS on their own.
When to seek medical help
See your GP if you think you have TOS. Seek an urgent GP appointment or contact NHS 111 for one-sided arm pain with swelling, redness and warmth, as this can be a sign of a blood clot.
Call 999 for sudden breathlessness with sharp chest pain and a cough or coughing up blood. Do not wait for a routine appointment. See the NHS information on thoracic outlet syndrome for further guidance.
Vascular vs Neurogenic TOS
Neurogenic TOS affects nerves; vascular TOS affects an artery or vein. The distinction matters because blood-vessel problems may need urgent specialist treatment. A normal-feeling wrist pulse does not rule out a circulation problem, and a pulse change during a movement test does not establish the diagnosis.
Your medical team may arrange further investigations and advise on the appropriate treatment. Follow the medical-help guidance above rather than trying to decide which type you have from symptoms or a home test.
Cervical Ribs Causing Thoracic Outlet Syndrome
Some people are born with an extra rib above the first rib, called a cervical rib. It often causes no symptoms, but in some people it contributes to pressure on nerves or blood vessels. Finding a cervical rib does not automatically mean that surgery is needed. A specialist considers the symptoms, examination and investigations when recommending treatment.
Managing TOS
Management depends on the type of TOS and the findings of your medical assessment. It may involve rehabilitation, medicines or specialist procedures. Suspected blood-vessel involvement needs medical care; routine hands-on treatment should not delay that assessment.
For some people with nerve-related TOS, a supervised rehabilitation programme may include gradual changes to shoulder movement, exercise and activity. Treatment should be individualised rather than based only on posture or the appearance of rounded shoulders.
If you attend Eastbourne Osteopathy with arm or shoulder symptoms, Andy will assess whether osteopathic care is appropriate and discuss referral where needed. This does not replace medical investigation for suspected TOS. For more general information, read our arm pain guide or shoulder pain page.