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Thoracic Outlet Syndrome (TOS) is characterized by the abnormal compression of nerves, arteries, and veins in the region between the cervical spine and the lower border of the axilla (armpit). This compression can be caused by various factors such as bony, ligamentous, or muscular obstacles.

The neurovascular bundle, which includes the brachial plexus, C8 and T1 nerve roots, and the subclavian artery and vein, can be affected by TOS. Symptoms of TOS can manifest as either neurological or vascular issues.

Neurological symptoms may include:

  • Paresthesia (tingling or numbness) along the inside forearm and palm
  • Muscle weakness and atrophy in the gripping muscles and small muscles of the hand
  • Difficulty with fine motor tasks of the hand
  • Cramps in the muscles of the inner forearm
  • Pain in the arm and hand
  • Tingling and numbness in the neck, shoulder region, arm, and hand

Vascular symptoms may include:

  • Swelling or puffiness in the arm or hand
  • Bluish discoloration of the hand
  • Feeling of heaviness in the arm or hand
  • Pulsating lump above the clavicle
  • Deep, toothache-like pain in the neck and shoulder region

Various factors can contribute to neurovascular compression in TOS, including tightness in the anterior scalene, compression in the space between the clavicle and the first rib, and tightness in the pectoralis minor.

Treatment of TOS typically involves a multifaceted approach, which may include:

  • Stretching of the back, neck, chest, and shoulder muscles
  • Mobilization of the first rib
  • Physiotherapy modalities such as ultrasound, electrical stimulation, or therapeutic exercises
  • Postural correction techniques

Overall, the goal of treatment for TOS is to alleviate compression on the affected neurovascular structures and improve symptoms and function.


1. Kaplan J, Kanwal A. Thoracic Outlet Syndrome. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

2. Li, N., Dierks, G., Vervaeke, H. E., Jumonville, A., Kaye, A. D., Myrcik, D., Paladini, A., Varrassi, G., Viswanath, O., & Urits, I. (2021). Thoracic Outlet Syndrome: A Narrative Review. Journal of Clinical Medicine, 10(5), 962-.

3. Chang, M. C., & Kim, D. H. (2021). Essentials of thoracic outlet syndrome: A narrative review. World Journal of Clinical Cases, 9(21), 5804–5811.

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