Thoracic Outlet Syndrome

What is it?

Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers.




In general, the cause of thoracic outlet syndrome is compression of the nerves or blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include:

  • Anatomical defects. Inherited defects may include a cervical rib or an abnormally tight fibrous band connecting your spine to your rib.
  • Poor posture. Drooping your shoulders or holding your head in a forward position can cause compression in the thoracic outlet area.
  • Trauma.
  • Repetitive activity. Athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements.
  • Pressure on your joints.
  • Pregnancy.


Signs and Symptoms

Symptoms can vary, depending on which structures are compressed.

Compression of nerves

  • Muscle wasting
  • Numbness or tingling in your arm or fingers
  • Pain or aches in your neck, shoulder or hand
  • Weakening grip

Compression of blood vessels

  • Discoloration of your hand (bluish color)
  • Arm pain and swelling, possibly due to blood clots
  • Weak or no pulse in the affected arm
  • Cold fingers, hands or arms
  • Arm fatigue with activity
  • Weakness of arm or neck



Physical therapy. Exercises can help strengthen the muscles surrounding the shoulder so that they are better able to support the collarbone. Postural exercises can help you stand and sit straighter, which lessens the pressure on the nerves and blood vessels.

Nonsteroidal anti-inflammatory medications. Drugs like naproxen and ibuprofen can ease the pain and reduce swelling.

Surgery. Removing a portion of an abnormal first rib, releasing a muscle that joins the neck and chest, or sometimes both.

Lifestyle changes. You may need to change your workstation layout, avoid strenuous activities and prolonged positions with the arms held out or overhead. It is also helpful to have rest periods at work to minimize fatigue.