Thoracic Outlet Syndrome: Symptoms, Causes & Treatment
Arm or hand numbness, tingling, weakness, or shoulder pain can have several possible causes. Learn what thoracic outlet syndrome is, what can cause it, and how an individualized approach to treatment may help.
Dr. Jeff Verenski
8/21/20268 min read
Thoracic Outlet Syndrome: Symptoms, Causes, and Treatment
Tingling, numbness, aching, or weakness in your arm or hand can be frustrating—especially when you can't figure out why it's happening.
If your symptoms seem to involve your neck, shoulder, upper chest, arm, or hand, thoracic outlet syndrome may be one possible explanation.
Thoracic outlet syndrome, often abbreviated as TOS, describes a group of conditions involving compression or irritation of nerves or blood vessels as they pass through the space between the neck and upper chest and toward the arm.
It is a relatively uncommon condition, and arm or hand symptoms can have many different causes. That's why a thorough examination is important before assuming that thoracic outlet syndrome is responsible.
At Resolve Chiropractic in Brookfield, WI, evaluation of neck, shoulder, and upper-extremity complaints may include assessing the cervical and thoracic spine, shoulder mechanics, muscular function, posture, mobility, strength, and neurological findings.
What Is Thoracic Outlet Syndrome?
The thoracic outlet is a passageway located between the lower neck and upper chest.
Several important structures travel through this area toward the arm, including:
The brachial plexus, a network of nerves supplying the arm
The subclavian artery
The subclavian vein
Thoracic outlet syndrome occurs when one or more of these structures become compressed or irritated.
There are several forms of TOS, and the symptoms can differ depending on which structure is involved.
The three general categories are:
Neurogenic Thoracic Outlet Syndrome
This is the most common type of TOS and involves compression or irritation of the brachial plexus.
Symptoms can include:
Tingling or numbness
Aching in the neck, shoulder, arm, or hand
Arm fatigue
Weakness
Symptoms that worsen with certain arm positions
Venous Thoracic Outlet Syndrome
Venous TOS involves compression of the subclavian vein.
It can cause swelling, heaviness, discoloration, or a feeling of fullness in the affected arm.
Because vascular problems can be serious, suspected vascular TOS requires appropriate medical evaluation.
Arterial Thoracic Outlet Syndrome
Arterial TOS involves compression of the subclavian artery.
Symptoms may include coldness, color changes, pain, or reduced circulation in the hand or arm.
Arterial symptoms require medical assessment because vascular compromise should not be treated as a routine musculoskeletal problem.
What Does Thoracic Outlet Syndrome Feel Like?
Symptoms vary depending on the structures involved and the individual.
Someone with neurogenic TOS might experience symptoms such as:
Numbness or tingling in the hand
Aching through the shoulder or arm
Pain around the neck or upper chest
Arm fatigue during overhead activity
Weakness or a feeling of heaviness
Symptoms that increase when the arm is elevated
Discomfort around the shoulder blade
Changes in sensation in portions of the arm or hand
Some people notice symptoms during activities such as:
Working overhead
Weightlifting
Swimming
Throwing
Reaching
Carrying objects
Working at a computer
Sleeping with the arms in certain positions
However, these symptoms aren't specific to thoracic outlet syndrome.
Cervical radiculopathy, peripheral nerve entrapments, shoulder conditions, and other problems can produce similar complaints.
What Causes Thoracic Outlet Syndrome?
There isn't always one obvious cause.
Several factors can contribute to symptoms involving the thoracic outlet.
Posture and Shoulder Position
The position of the head, neck, shoulder blades, and upper extremities can influence the space through which nerves and blood vessels travel.
For some people, prolonged positioning or repetitive activity may contribute to symptoms.
However, posture alone shouldn't automatically be considered the cause of someone's symptoms.
Repetitive Overhead Activity
Activities that repeatedly place the arms overhead can increase demand on the muscles and structures around the neck and shoulder.
Athletes, swimmers, painters, electricians, construction workers, and others who frequently work with their arms overhead may experience symptoms with these activities.
Muscle Tightness or Imbalances
The muscles surrounding the neck, chest, shoulder blade, and upper back all contribute to shoulder and upper-extremity movement.
Changes in mobility, strength, or muscular coordination may influence how the shoulder girdle moves.
Trauma
A previous injury to the neck, shoulder, or upper chest can sometimes contribute to symptoms.
Motor vehicle accidents, falls, sports injuries, and other forms of trauma can affect the muscles, joints, and nerves in the region.
Anatomical Factors
Some people have anatomical variations that can contribute to narrowing around the thoracic outlet.
A cervical rib is one example.
Importantly, having a cervical rib does not automatically mean someone has thoracic outlet syndrome. Many people with anatomical variations have no symptoms.
Is Thoracic Outlet Syndrome the Same as a Pinched Nerve in the Neck?
No.
The symptoms can look similar, but the location of the nerve involvement is different.
With cervical radiculopathy, a nerve root is irritated or compressed near the cervical spine.
With neurogenic thoracic outlet syndrome, the brachial plexus is affected farther along its path between the neck and upper extremity.
Both conditions can cause:
Arm pain
Tingling
Numbness
Weakness
Symptoms that change with movement
This is one reason diagnosing the cause of arm symptoms can be challenging.
A careful history and physical examination can help determine which conditions should be considered.
How Is Thoracic Outlet Syndrome Diagnosed?
There isn't one simple test that can diagnose every case of thoracic outlet syndrome.
Diagnosis typically involves combining the patient's history with a physical examination and, when appropriate, additional testing.
Your healthcare provider may evaluate:
Neck movement
Shoulder movement
Arm and hand strength
Sensation
Reflexes
Grip strength
Scapular movement
Muscle function
Vascular changes
Symptoms associated with different arm positions
Certain clinical tests may be used as part of the examination, but no single provocative test should be viewed as definitive on its own.
Additional testing may sometimes be appropriate.
Depending on the presentation, this can include imaging, nerve studies, vascular testing, or referral to another healthcare professional.
Can Chiropractic Care Help Thoracic Outlet Syndrome?
For some people with musculoskeletal contributors to neurogenic thoracic outlet symptoms, conservative care may be appropriate.
The goal shouldn't be to simply "adjust the neck" and hope the symptoms disappear.
Instead, treatment should address the factors identified during the examination.
Depending on the individual, chiropractic care may include:
Thoracic and Cervical Joint Treatment
Restricted mobility in the cervical and thoracic spine may contribute to altered movement patterns.
When appropriate, chiropractic adjustments or mobilization techniques may be used to improve joint mobility.
Soft-Tissue Treatment
The muscles around the neck, chest, shoulder, and upper back can be evaluated for areas of increased tension or tenderness.
Manual therapy may be used when appropriate to address these findings.
Shoulder Blade and Thoracic Mobility
The shoulder blade doesn't operate independently from the rest of the body.
Its movement is influenced by the thoracic spine, ribs, neck, and surrounding muscles.
Improving mobility and movement control can be an important part of rehabilitation for some patients.
Therapeutic Exercise
Exercise is often an important component of conservative treatment.
Depending on your presentation, exercises may focus on:
Scapular control
Thoracic mobility
Cervical stabilization
Rotator cuff strength
Postural endurance
Pectoral mobility
Breathing mechanics
Gradual tolerance to overhead activity
Exercises should be individualized rather than assuming that everyone with arm tingling needs the same routine.
What Exercises Are Used for Thoracic Outlet Syndrome?
There isn't one universal exercise program for TOS.
The appropriate exercises depend on what is contributing to the individual's symptoms.
A rehabilitation program may include exercises designed to improve thoracic mobility, shoulder blade control, neck stability, and overall shoulder function.
Examples may include:
Scapular retraction exercises
Serratus anterior strengthening
Thoracic extension mobility
Cervical stabilization exercises
Pectoral stretching
Rotator cuff strengthening
Controlled overhead movements
However, exercises that feel appropriate for one person can aggravate another person's symptoms.
If an exercise consistently increases numbness, tingling, weakness, or arm pain, it should be reassessed rather than simply pushed through.
Can Thoracic Outlet Syndrome Go Away?
Some people experience significant improvement with conservative management, particularly when symptoms are related to modifiable musculoskeletal and movement factors.
Recovery depends on the type of TOS, severity of symptoms, duration, underlying anatomy, and response to treatment.
The goal isn't necessarily to eliminate every symptom immediately.
Progress can also be measured by improvements such as:
Less frequent tingling
Reduced arm pain
Improved tolerance for overhead activity
Better shoulder movement
Increased strength
Improved exercise tolerance
Ability to perform work and daily activities with fewer symptoms
If symptoms aren't improving as expected, further evaluation may be appropriate.
When Should You See a Doctor for Thoracic Outlet Symptoms?
Arm numbness and tingling shouldn't automatically be assumed to be thoracic outlet syndrome.
You should seek appropriate medical evaluation if you experience significant or progressive neurological or vascular symptoms.
Particularly concerning symptoms can include:
Significant or rapidly worsening weakness
Persistent loss of sensation
Swelling of the arm
Significant discoloration of the hand or arm
Unusual coldness of the hand
Severe or unexplained vascular symptoms
Sudden neurological symptoms, severe weakness, or other potentially serious symptoms should be evaluated urgently.
A chiropractor should also refer a patient for additional evaluation when the presentation falls outside the appropriate scope of conservative musculoskeletal care.
Thoracic Outlet Syndrome vs. Other Causes of Arm Tingling
One of the biggest challenges with TOS is that several other conditions can produce similar symptoms.
Possible causes of arm or hand tingling include:
Cervical radiculopathy: A nerve root is irritated near the cervical spine.
Carpal tunnel syndrome: The median nerve is compressed at the wrist.
Cubital tunnel syndrome: The ulnar nerve is irritated around the elbow.
Shoulder conditions: Problems involving the shoulder can sometimes produce pain extending into the arm.
Peripheral nerve irritation: Nerves can become irritated at multiple locations along their pathway.
Thoracic outlet syndrome: Nerves or blood vessels are affected as they pass through the thoracic outlet.
Because these conditions can overlap, identifying the location and behavior of symptoms is important.
What Happens During a TOS Evaluation at Resolve Chiropractic?
At Resolve Chiropractic in Brookfield, the evaluation begins with understanding your symptoms.
You'll be asked about things such as:
Where your symptoms begin
Where they travel
When they occur
What activities make them worse
Whether overhead activity changes your symptoms
Whether you experience numbness or tingling
Whether you've noticed weakness
Previous injuries
Work and exercise demands
Your goals for treatment
The physical examination may include assessment of the cervical and thoracic spine, shoulder mobility, scapular mechanics, strength, sensation, and neurological findings.
The goal is to determine whether the symptoms appear consistent with a musculoskeletal problem that may respond to conservative care and whether referral or additional testing is warranted.
Thoracic Outlet Syndrome Treatment in Brookfield, WI
If you're experiencing arm numbness, tingling, shoulder pain, or symptoms that worsen with overhead activity, it's worth getting an appropriate evaluation rather than assuming the problem is simply a tight muscle or pinched nerve.
At Resolve Chiropractic in Brookfield, WI, care is individualized based on your symptoms, examination findings, activity level, and goals.
Treatment may include chiropractic adjustments, manual therapy, soft-tissue techniques, mobility work, and therapeutic exercise when appropriate.
The goal is to identify the factors contributing to your symptoms and develop a treatment approach that helps you return to the activities that matter to you.
Frequently Asked Questions About Thoracic Outlet Syndrome
What is thoracic outlet syndrome?
Thoracic outlet syndrome is a group of conditions involving compression or irritation of nerves or blood vessels as they pass through the thoracic outlet between the neck and upper chest.
What are the symptoms of thoracic outlet syndrome?
Symptoms can include arm or hand numbness, tingling, pain, weakness, heaviness, fatigue, swelling, or changes in skin color or temperature depending on which structures are involved.
Can a chiropractor treat thoracic outlet syndrome?
Conservative chiropractic care may be appropriate for some patients, particularly when musculoskeletal and movement-related factors contribute to neurogenic symptoms. Treatment should be individualized and may include manual therapy, mobility work, adjustments, and therapeutic exercise.
Is thoracic outlet syndrome caused by bad posture?
Posture may contribute to symptoms in some individuals, but it is rarely appropriate to assume that posture alone is the cause. A thorough evaluation should consider multiple possible contributors.
Can TOS cause numbness in the hand?
Yes. Neurogenic TOS can cause numbness or tingling in the arm or hand. However, several other conditions can cause similar symptoms, including cervical radiculopathy and peripheral nerve entrapments.
Can exercise make thoracic outlet syndrome worse?
Certain activities, particularly repetitive or prolonged overhead activity, may aggravate symptoms in some people. Exercise can still be an important part of rehabilitation, but exercises should be selected and progressed based on the individual's response.
When should I see a doctor for arm numbness?
Persistent, worsening, or significant numbness should be evaluated. Arm swelling, significant color or temperature changes, rapidly worsening weakness, or other vascular or neurological symptoms warrant prompt medical assessment.
Dealing With Arm or Shoulder Symptoms?
If you're experiencing neck pain, shoulder discomfort, arm tingling, numbness, or symptoms that worsen with overhead activity, there may be more going on than a simple muscle strain.
Thoracic outlet syndrome is only one possible explanation, which is why identifying the source of your symptoms is an important first step.
If you're in Brookfield, Waukesha, Elm Grove, Wauwatosa, New Berlin, or the surrounding Milwaukee area, Resolve Chiropractic can evaluate your symptoms and determine whether conservative chiropractic care may be appropriate.
Contact Resolve Chiropractic in Brookfield, WI to schedule an evaluation.
This article is intended for general educational purposes and is not a substitute for an individualized medical evaluation or diagnosis. If you are experiencing significant or rapidly progressing neurological or vascular symptoms, seek appropriate medical attention.