Between 7 and 47 percent of working-age adults experience pain in this joint at least once in a while.
This condition usually appears especially to those who work in clinics and have occupations that require the use of their arms in elevation (such as hairdressers / barbers, switchboard operators, etc.)
Although thoracic outlet syndrome ( TOS ) has always been considered a somewhat “rare” condition that causes shoulder / arm / chest pain, there is some evidence that it has become more common in recent decades.
One possible explanation for the rising rates of TOS is that many adults now sit for too many hours of the day, due to having sedentary “desk jobs.”
Sitting all day is problematic on its own, but most people also have poor posture, which contributes to stiffness as well as certain chronic diseases.
On the other hand, TOS can also affect athletes and certain types of manual workers who use their arms and hands repetitively, such as weightlifters, cyclists, throwers, construction workers, etc.
These groups of people are at increased risk for symptoms of thoracic outlet syndrome, which include tingling in the hands, weakness in the arms, pressure on the neck, and pain in the collarbone or shoulder.
What can be done to improve thoracic outlet syndrome?
Physical therapy, targeted stretching, and regular exercise are key components of thoracic outlet syndrome treatment.
Other steps that can help prevent and treat TOS include fixing your workstation settings, improving your posture, stretching regularly, and following an anti-inflammatory diet.
What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a general term that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest, shoulders, and arms.
Technically, thoracic outlet syndrome is caused by abnormal compression of the thoracic outlet (the space between the clavicle and the first rib and the neurovascular bundle of small bones, ligaments, and muscles in the cervical spine and lower armpit (the armpit or the armpit).
Main types of thoracic outlet syndrome
There are 3 main types of thoracic outlet syndrome:
- Neurogenic TOS.
- Vascular TOS.
- The arterial TOS.
Each type of TOS causes somewhat unique symptoms, although there is a lot of overlap between the different types.
It is the most common, followed by venous and then arterial. Up to 85-95 percent of all patients with thoracic outlet syndrome are affected by neurogenic TOS.
This type is characterized by compression of the nerve roots of the brachial plexus (C5 to T1), which extends from the spine to the extremities.
It is characterized by compression of the subclavian vein / artery in the space between the clavicle and the first rib. This type is related to thrombosis or the formation of a blood clot within a blood vessel in the subclavian vein.
Pulmonary embolism can also occur rarely, especially when there is a lot of movement of the arms.
It is caused by compression of the subclavian artery. This is a main artery that runs from the chest to the arm.
The symptoms of TOS can be very similar to those caused by Raynaud’s syndrome, which is also associated with numbness and coldness in the hands, paleness or changes in the color of the fingers, and sometimes pain or tingling.
Many people with Raynaud’s syndrome (or Raynaud’s disease) have another health condition that affects their arteries or nerves, one of which may be TOS.
Symptoms of thoracic outlet syndrome
The most common thoracic outlet syndrome symptoms include:
- Tenderness in the supraclavicular area (the space above the clavicle where the chest, esophagus, and lungs meet).
- Numbness, tingling, and / or “tingling” sensations in the arms and hands (also called paresthesias). This is more likely to occur when lifting and raising your hands.
- Weakness in the neck, shoulders, arms and hands. Weakness is commonly felt in the fingers and on the edge of the hands. Which fingers are most affected by thoracic outlet syndrome? Usually the fifth (little) finger will be affected, but symptoms can also appear on the other fingers.
- Pale palms or fingers of one or both hands, or changes in the color of the arms, such as blue or red spots. This is most likely to be noticed when the hands are raised above the shoulders.
Symptoms of thoracic outlet syndrome differ depending on the type of TOS someone has.
Neurogenic TOS (also called the Gilliatt-Sumner hand) causes severe wear on the fleshy base of the thumb.
It can also cause:
- Feeling of being injured by pins and needles.
- Changes in the color of the hand.
- Including pale / white hands.
- Cold in the hands.
- Dull pain in the neck and pain in the shoulders and near the armpits.
Venous TOS (of which Paget-Schroetter syndrome is a subset) causes:
- Pale / pale hands.
- Weak pulse in the affected arm.
- Coldness in the hands.
- Swelling of the fingers
- Neck weakness
Arterial TOS causes:
- Very noticeable changes in color and sensitivity to cold in the hands and fingers.
- Heaviness and poor blood circulation in the arms, hands, and fingers.
Causes and risk factors
Among physicians who specialize in treating conditions like TOS, there is still an ongoing debate about the exact physiological causes of the condition.
Many agree that TOS is related to compression of the brachial plexus or subclavian vessels that travel down the neck to the armpit and arms.
The nerves that lead to the arms come from the spine through the neck, through the shoulders, and through the arms. They can become irritated and tense due to poor posture, repetitive movements, and for other reasons.
Compression occurs when the size and shape of the thoracic outlet is altered. This can be caused by a number of different factors, depending on the person’s general health and genetics.
Can trauma cause thoracic outlet syndrome?
Yes, physical trauma is one of the most common causes of thoracic outlet. For example, symptoms may be due to an accident, a surgical procedure, or after a frostbite.
Other reasons that someone may develop TOS include:
- History of injuries affecting the neck, arms, and hands.
- Poor posture causing nerve compression, especially forward head posture that pulls on the neck.
- Do repetitive arm and shoulder movements. This can include movements involved in certain lines of work, or the types done during exercise, when playing sports, or during other physical activities.
- Born with anatomical defects that cause nerve compression.
- Tumors that press on the nerves.
- The pregnancy.
Risk factors for developing thoracic outlet syndrome
Risk factors for TOS include:
- Being a woman, since women are affected more often than men.
- Being between the ages of 20 and 50, which is when symptoms usually start.
- Live a sedentary lifestyle, with very little physical activity.
- Being a high-level athlete, especially playing baseball, softball, wrestling, swimming, hockey, martial arts, backpacking, and billiards (all of this has been linked to venous TOS).
- Coping with chronic stress , which can put stress on the neck.
- Obesity or being very overweight.
- History of diabetes, neuropathy, and other nerve-related conditions.
- Sleep deprivation and depression, causing tight muscles and worsening inflammation / pain.
- Smoking and high alcohol consumption.
Symptoms can be made worse by taking certain medications that cause arteries to narrow and reduce blood flow.
These may include:
- Beta Blockers.
- Contraceptive pills.
- Allergy medications.
- Pills for diet.
- Migraine medicines that contain ergotamine.
- Some anticancer drugs, such as cisplatin and vinblastine.
Conventional treatment for thoracic outlet syndrome
What does research suggest about the prognosis of thoracic outlet syndrome?
Most people with TOS will find relief from symptoms by following an exercise and physical therapy program that addresses compression of their nerves and arteries.
However, some people with more severe cases of TOS, especially vascular and neurogenic TOS, may need medications or have surgery to recover.
It is important to discuss any TOS symptoms you may experience with your doctor to get an accurate diagnosis of thoracic outlet syndrome.
Be aware that there are many other conditions and disorders that affect the nerves and blood vessels in the upper body that can cause symptoms similar to TOS.
For example, your symptoms may actually be due to:
- Raynaud’s disease / Raynaud’s syndrome.
- Frozen shoulder.
- Cervical disc disorders.
- Rotator cuff injuries.
- Multiple sclerosis.
- Complex regional pain syndrome.
- Tumors of the syrinx or spinal cord.
If your doctor suspects you may have TOS, you will likely want to run multiple tests for thoracic outlet syndrome.
TOS can be diagnosed after a physical exam that reveals tenderness in the supraclavicular area, upper body weakness, and / or “pins and needles” in the arms.
Your doctor will also want to review your medical history, exercise routine, and any other symptoms that you are experiencing. Depending on your symptoms, he may recommend other tests to rule out or diagnose TOS, such as conduction studies, electromyography, or imaging studies.
Treatment options for thoracic outlet syndrome may include one or more of the following:
- An exercise program used to strengthen and stretch the muscles of the chest, shoulders, and neck.
- Physical therapy to help restore normal posture, strengthen key muscles, and relieve compression on affected nerves. Heat can also be used to aid stretching / exercises as it relaxes the muscles.
- Use of non-steroidal anti-inflammatory drugs (NSAIDs) to help decrease pain.
- Use of blood thinners and thrombolytic medications, which are used to prevent and break down blood clots.
In rare cases, surgery may also be recommended if other treatment options do not work to relieve symptoms. What procedure is done to relieve thoracic outlet syndrome?
The goal of TOS surgery is the decompression / release of the affected nerves or arteries.
8 stretches and exercises for thoracic outlet syndrome
Below are exercises for thoracic outlet syndrome that experts recommend that you ideally perform on a daily basis to help manage your symptoms. Always perform TOS exercises slowly and carefully so you don’t strain and cause more pain.
The goal is to perform upper body and shoulder exercises to help strengthen the chest and stretch tight areas to the point where a stretch is intensely felt but painless.
Hold each stretch underneath for 30 seconds and then slowly release. Take about 10 seconds between each stretch to rest. Repeat all stretches ideally three to five times.
1. Back of neck stretch : sitting or standing, interlock your fingers behind your head. Gently tilt your head back with the support of your hands as you lift your chest, then invert and place your chin on your chest. Move slowly and back and forth as you breathe.
2. Side of the neck lift : Sit in a chair and place the affected hand behind the head. Turn your head from the tight side, look down until you feel a slight stretch. Take a deep breath, exhale slowly while holding it.
3. Chest Stretch : Sit in a sturdy chair next to a table. Place your arms on the table directly in front of you. Lean forward as you bend at the waist as much as possible while extending your head and chest forward.
4. Shoulder Stretch: Stand with your back to a table and roll your arms back to try to grasp the edge of the table with your fingers. While looking forward, slowly bend your knees and allow your elbows to bend.
5. Pectoral Stretch : Stand in an open doorway and raise your hands above your head to reach the doorframe. Slowly lean forward until you feel a stretch in the front of your shoulders.
6. Rowing Exercise : Wrap an exercise band / tube around an immovable object. Hold one end of the band in each hand. Sit in a chair, bend your arms 90 degrees and pull back on the band while squeezing your shoulder blades. Try to complete two sets of 15.
7. Mid-Trap Exercise : Lie on your stomach and place a folded pillow under your chest. Place your arms out at your sides with your elbows straight and your thumbs up.
Slowly raise your arms towards the ceiling while squeezing your shoulder blades (as if you are squeezing an orange between your shoulders). Try to complete three sets of 15.
8. Flies: Hold a light dumbbell in each hand near your hips while standing, rather than lifting the weight laterally a few inches from your body with your arms straight.
Lift the arms of your body outwards, forming a “V” upside down. Bring the weights toward your hips and repeat 10 to 12 times.
If you feel more comfortable, you can also perform flys while sitting or with your arms bent (sometimes called a ‘bent arm side lift’).
The best way to add strength to your upper body is to do exercises that target different parts of your shoulders, chest, and arms. As long as you are not in pain, this can be done using various types of body movements, dynamic movements, and weighted exercises.
Here is a list of exercises that can be incorporated into your workouts to improve range of motion and strength:
- Plank variations.
- All types of push-ups, including TRX push-ups.
- Rowing exercises.
- Air presses.
- Cable pulls.
- Lateral raises.
- Yoga movements that involve supporting the weight of the upper body.
Prevention of thoracic outlet syndrome
1. Fix your job setup
If you spend a lot of time sitting at a desk working every day, adjust your workstation to avoid sitting with poor posture and slouching throughout the day.
This is important because poor posture can cause problems related to inadequate blood supply to the arms for long periods. To avoid sitting all day, you may also consider using a standing desk, which usually helps prevent slouching.
Set up your desk and computer so that your chin / mouth is parallel to the ground and your eyes are looking at the top third of the screen.
Keep your arms relaxed so your wrists are a natural extension of your forearms and your mouse is level with or below the keys.
Don’t lean your neck and go ahead. You want your head to be at or behind your hip joint. Your torso should recline slightly at an angle of 91 to 112 degrees.
Your knees should be bent and roughly in line with your hips. You don’t want your knees to be more than three inches above or below your hip joints.
2. Manage stress
Stress can worsen the symptoms of thoracic outlet syndrome, increasing muscle tension and tension. Emotional or physical stress can cause vasoconstriction, further affecting blood flow.
Try to relieve stress like practicing yoga, going for a walk, or taking time to meditate or pray devotionally every day.
If you are dealing with a lot of emotional stress, you can also consider cognitive behavioral therapy or join a support group.
Acupuncture can be helpful in reducing stress-related symptoms, such as joint pain, swelling, and stiffness.
Use soothing essential oils like lavender, ylang ylang, and chamomile oil.
Try mind-body practices like spinal manipulation, meditation, reiki, guided imagery, deep breathing exercises, and other relaxation techniques.
3. Give yourself plenty of recovery time
Exercise is beneficial in many ways, but overtraining can contribute to TOS, especially if you exercise poorly and don’t allow enough time between workouts for muscles and joints to heal.
Take breaks from the exercises or repetitive movements that contribute to your symptoms. Take two days between hard workouts to properly recover.
An effective way to do this is to focus on different muscle groups in each workout so that you can rotate the parts of the body.
I also recommend rolling / using a pointy ball to help keep muscles loose. Massage therapy, working with a physical therapist, and visiting a chiropractor are other options if you have problems with poor form, reduced range of motion, and a lot of stiffness.
4. Reduce inflammation
Stop smoking and avoid consuming too much alcohol.
Eliminate inflammatory foods from your diet, including those that contain added sugar, processed oils, refined carbohydrates, artificial and chemical ingredients, alcohol, and even caffeine.
Instead, eat anti-inflammatory foods like: green leafy vegetables, berries, wild salmon and bone broth, nuts and seeds, good quality organic meats, fresh vegetables, spices and herbs.
Avoid very hot or cold temperatures that can make symptoms like tingling and color changes in your hands worse.
5. Check your medications
If you are taking any medications that can reduce blood flow, this can contribute to TOS. Talk to your doctor about some alternatives.
If you are treating thoracic outlet syndrome for the first time, I recommend that you consult a physician before beginning any treatment program.
Make sure to rule out any other conditions that may be causing you pain and discomfort. If you notice that your symptoms get worse when you start exercising and stretching, always make sure to stop and see your doctor for help.
Key points about thoracic outlet syndrome
Thoracic outlet syndrome (TOS) is a generic term that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest, and arms.
The three types of TOS are: neurogenic, vascular, and arterial. Neurogenic is by far the most common type.
Symptoms of thoracic outlet syndrome include: tenderness, numbness, tingling, and / or “tingling” in the arms and hands (also called paresthesia); weakness in the neck, shoulders, arms, and hands; paleness or changes in the color of the fingers; pain, swelling, and tenderness in the upper body.
There are many different causes of thoracic outlet syndrome, some of which may include:
Injuries affecting the neck, arms, and hands; poor posture causing nerve compression; repetitive arm and shoulder movements, doing certain repetitive exercises; anatomical defects; tumors that press on nerves; and pregnancy
Exercise and physical therapy are recommended treatments for TOS. Some may also need medicine to control pain or blood clots and, rarely, surgery.