Thoracic outlet syndrome is a group of conditions in which the nerves or blood vessels running between the neck and the armpit are squeezed, usually between the collarbone, the first rib and the neck muscles. The most common type affects the nerves and causes arm pain, tingling in the hand and heaviness when working overhead. It is an uncommon and much-debated diagnosis, so other causes of arm symptoms should be checked first.
Also known as TOS, neurogenic thoracic outlet syndrome
Symptoms
- Aching in the neck, shoulder and arm
- Tingling or numbness in the hand, often in the ring and little fingers
- An arm that feels heavy or tires quickly when working overhead
- A weaker or clumsier grip
- Swelling or a bluish colour in the arm (vein type)
- A cold, pale hand or fingers (artery type)
Causes and risk factors
- An extra rib in the neck or a tight band of tissue you were born with
- A neck injury such as whiplash
- Repeated overhead work or sport, such as swimming, throwing, painting or hairdressing
- Tight or enlarged muscles at the side of the neck or the front of the chest
- A previous collarbone fracture
What the evidence says helps
- Diagnosis rests on the pattern of symptoms and examination, and on ruling out other causes such as a trapped nerve in the neck or carpal tunnel syndrome. There is no single definitive test.1
- A Cochrane review found only very low-quality evidence for any treatment and called for better trials, so recommendations rest largely on clinical experience.2
- For the nerve type, care usually starts with several months of physiotherapy-style treatment: exercises for the neck and shoulder blade muscles, posture and activity changes, and nerve-gliding movements.3
- Surgery to create more space, usually removing the first rib, is considered when symptoms persist despite conservative care.31
- The vein and artery types are different: they need prompt assessment by a vascular team and are often treated with blood thinners or surgery.3
Things you can try at home
- Break up overhead work and heavy carrying with regular rests
- Avoid heavy shoulder bags and tight rucksack straps
- Try not to sleep with your arms above your head
- Keep the neck and shoulder blades moving with gentle exercise
- Build activity back up gradually, staying within mild discomfort
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Sudden swelling, heaviness or blueness of a whole arm: go to A&E, as this can be a blood clot
- A cold, white or very painful hand, or sores on the fingertips: get urgent medical help
- Arm pain with chest pain, breathlessness or sweating: call 999
- Weakness that is getting worse, or wasting of the muscles in the hand: see your GP promptly
- A new lump above the collarbone or unexplained weight loss: see your GP
How Apollo can help
We examine the neck, shoulder, nerves and circulation of the arm to work out where your symptoms are coming from, because trapped nerves at the neck, elbow or wrist are far more common and can look similar. If thoracic outlet syndrome seems likely, we build a programme of exercise for the shoulder blade and neck muscles, hands-on treatment where appropriate and changes to the activities that set it off. If we find any sign of a blood vessel problem, or you are not improving, we refer you to your GP for further tests.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
What does thoracic outlet syndrome feel like?
Most people describe an ache around the neck and shoulder with tingling in the hand, often the ring and little fingers, and an arm that feels heavy or tired when used overhead. Symptoms tend to come and go with activity and position.
How is thoracic outlet syndrome diagnosed?
There is no single test. Diagnosis is based on your symptoms and examination, and on ruling out more common problems. Your GP may arrange an X-ray to look for an extra rib, nerve tests or a scan of the blood vessels.
Will I need surgery for thoracic outlet syndrome?
Most people with the nerve type start with exercise-based treatment, and many do not need surgery. Surgery is considered if symptoms continue despite several months of good conservative care, and more readily for the rarer blood vessel types.
References
- Illig KA, et al. (2016). Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. Journal of Vascular Surgery 64:e23-e35. View source
- Povlsen B, Hansson T, Povlsen SD (2014). Treatment for thoracic outlet syndrome. Cochrane Database of Systematic Reviews 2014. View source
- Jones MR, et al. (2019). Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment. Pain and Therapy 8:5-18. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
