What is thoracic outlet syndrome?

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Thoracic outlet syndrome is a complex ailment where the blood vessels and/or nerves are compressed or entrapped while exiting the thorax. The condition is brought about by crushing of the brachial plexus or subclavian vessels once they depart from the neck up to shoulder area and move beneath the first rib.


Thoracic outlet syndrome is characterized by the following symptoms:

  • Pain, altered sensation and weakening of the upper limb
  • Achiness or discomfort that is often experienced above or beneath the collarbone and might radiate down the arm
    Achiness or discomfort that is often experienced above or beneath the collarbone and might radiate down the arm.
  • Disrupted sensation and temperature in the arm and hand
  • The symptoms are aggravated or worsened when lifting the arm or turning the neck or head

It is important to note that the symptoms tend to vary and often hard to distinguish from other shoulder conditions such as rotator cuff or cervical radiculopathy.

What are the risk factors?

  • Trauma
  • Bony irregularities
  • Weight gain
  • Poor posture
  • Sports or occupations involving repeated overhead movements

The symptoms might intensify during overhead movement during assessment. If an individual is suspected with thoracic outlet syndrome, the doctor might require a cervical spinal X-ray to assess for the presence of a cervical rib or protuberant C7 transverse process that contributes to the symptoms. Additional testing such as EMG or MRI might be required to rule out other possible causes.

Management of thoracic outlet syndrome

  • Adequate rest from aggravating activities
  • Strengthening of the shoulder blade stabilizing muscles
  • Posture correction
  • Mobilization of the thoracic spine and 1st rib
  • Massage of the chest, neck and upper back muscles
  • Ergonomic assessment

Take note that surgery is only considered if conservative treatment options could not effective manage the condition.

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