Compression of the nerves or blood vessels in the space that lies between the collar bone and the first rib is referred to as Thoracic Outlet Syndrome (TOS). A network of nerves known as the brachial plexus emerges from the spine and spreads out to the shoulder, neck, arms and hands. These nerves control the sensation in these parts of the body. Compression of the brachial plexus may result in a host of symptoms.


  • Trauma due to vehicular accident (Whiplash injury)
  • Congenital anatomical disorders such as presence of an extra rib bone
  • Pregnancy related changes in the body
  • Occupational injuries
  • Overuse, repeated stress and trauma caused to the thoracic part
  • Carrying heavy weight backpacks
  • Athletes such as golfers, swimmers may develop this condition
  • Compression of the thoracic area due to bad postural habits
  • Tightening of the fibrous band which connects the rib to the spine
  • Females are at a higher risk
  • Mental stress
  • Tumor in the chest or underarm


  • Numbness in the fingers
  • Pain in the shoulder, neck and thoracic region
  • Pin worsens with movement
  • There may be muscle wasting in the fleshy part at the base of the thumb
  • Tingling sensation in the arms, neck and hands
  • The grip may become weak
  • The hand may develop a bluish colour
  • Blood clots may lead to swelling in the affected part
  • A throbbing sensation in the collar bone


  • The patient’s lifestyle, activities and occupational details may be analyzed
  • The patient may be asked to move the arm, neck, shoulders and hands to check for symptoms
  • Details of medical history may be taken
  • Some provocation may be done to recreate the symptoms and assess the condition
  • X-ray imaging
  • Ultrasound test
  • MRI and CT Scan
  • Angiography
  • Nerve conduction test
  • EMG or electromyography


  • Most patients can be treated by conservative methods of treatment. These may include the following.
  • Physical therapy may be recommended in most cases to strengthen the shoulder and neck muscles
  • Prescription of anticoagulants to prevent or dissolve blood clots
  • Pain relief measures may include medicines, anti inflammatory medicines and muscle relaxants
  • Thoracic Outlet Decompression- a surgical process to reduce the pressure on the veins or arteries in the affected part. This may be done to remove a part of the rib or the muscle that causes pressure on the artery or vein
  • In some cases a damaged part of the nerve or the vein is removed and it is replaced by a nerve graft

Consult the physicians at OrthoTexas for treatment of Thoracic Outlet Syndrome. For an appointment, call 972-492-1334.