Is thoracic outlet syndrome common?

Thoracic outlet syndrome is relatively uncommon and often underdiagnosed because symptoms overlap with many other conditions. Neurogenic TOS is the most common type, accounting for about 95% of cases.

Can thoracic outlet syndrome be caused by poor posture?

Yes, poor posture such as forward head position and rounded shoulders can contribute to narrowing of the thoracic outlet and compression of nerves and blood vessels.

Does thoracic outlet syndrome require surgery?

Many cases respond to physical therapy and conservative measures. Surgery is reserved for cases that do not improve with conservative treatment or for vascular TOS with blood clots or arterial damage.

MusculoskeletalICD-10: G54.0Estimated to affect 3-80 per 1,000 people, though exact prevalence is debated

Thoracic Outlet Syndrome

Also known as: TOS

Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the thoracic outlet—the space between the collarbone and the first rib—become compressed. This can cause pain in the shoulders and neck, numbness in the fingers, and weakness in the hand. Treatment typically involves physical therapy, though severe cases may require surgery.

Symptoms

Pain in the neck, shoulder, or arm

Numbness or tingling in the fingers

Weakened grip strength

Arm fatigue with overhead activities

Swelling or discoloration of the arm in vascular types

Cold fingers or hands

Visible wasting of the hand muscles in severe cases

Causes

Cervical rib or fibrous band compressing structures
Poor posture causing narrowing of the thoracic outlet
Repetitive overhead arm movements
Trauma from a car accident or sports injury
Anatomical variations in the thoracic outlet

Risk Factors

Anatomical defects such as an extra rib
Poor posture
Repetitive overhead activities at work or in sports
Obesity
Pregnancy
Female sex

Diagnosis

Physical examination with provocative maneuvers (Adson's, Wright's, Roos tests)
Nerve conduction studies and electromyography
Ultrasound or CT angiography for vascular compression
MRI of the brachial plexus
Chest X-ray to identify cervical rib

Treatment

Physical therapy focusing on posture correction and shoulder strengthening
NSAIDs and muscle relaxants for pain
Nerve gliding exercises
Botulinum toxin injections for scalene muscle spasm
Surgical decompression including first rib resection for severe cases
Anticoagulation for vascular TOS with blood clots

Prevention

Maintaining good posture
Taking breaks during repetitive overhead work
Strengthening shoulder and neck muscles
Avoiding carrying heavy bags on one shoulder

When to See a Doctor

Persistent numbness, tingling, or weakness in the arm or hand
Arm swelling or color changes suggesting vascular compression
Symptoms that worsen with overhead activities
Blood clot symptoms in the arm

Frequently Asked Questions

Related Conditions

Carpal Tunnel Syndrome

Musculoskeletal

Deep Vein Thrombosis

Cardiovascular

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