Thoracic Outlet Syndrome (TOS)

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TOS results when nerves in the thoracic outlet—located between the upper ribs and shoulder—get irritated by the surrounding muscles or ribs.

Thoracic Outlet Syndrome

This is a label given to a group of disorders. In these disorders, nerves or blood vessels are compressed in the space between your collarbone and the underlying rib. This space is called the "thoracic outlet".

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  • Numbness, tingling, burning, and weakness in the arm and hand.
  • Pain in the neck, upper back, shoulder, or arm.
  • Possible temperature changes and swelling in the hand due to irritated blood vessels.
  • Symptoms may be worsened by working with arms out in front, lifting the arm over the head (such as brushing hair), and repetitive activities (such as typing or computer use).



Yes, it is not unusual to see other problems such as carpal tunnel syndrome, neck and upper back injuries, and shoulder injuries.
Problems can develop anywhere the irritated nerves go through a tight area.


  • The first part of the diagnosis is a good patient history and careful physical examination.
  • MRIs and x-rays usually do not show TOS.
  • To help confirm TOS diagnosis, an anesthetic block of the scalene or other pinched muscles may be performed with EMG guidance, which measures electrical activity in muscles. If this procedure temporarily relieves symptoms, it is highly suggestive of TOS.
  • Other causes of arm and hand numbness can be ruled out with an EMG-nerve conduction study
  • Non-invasive ultrasound vascular studies and surgical consultation may also be performed.

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