Thoracic Outlet Syndrome (TOS) refers to a group of conditions that occur from compression of the nerves and blood vessels that travel from the neck to the armpit region. It is caused by entrapment of the brachial plexus and subclavian vessels as they leave the thorax. The most common site of compression is the space between the collarbone and the 1st rib. Find out more about this condition and how we go about treating it at Harris & Ross here-

There are two different types of Thoracic Outlet Syndrome: Vascular and Neurological. Neurological is the most common.

TOS Anatomy

Structures that are usually compressed include:

  • Lower nerve roots of the Brachial plexus
  • Subclavian artery
  • Subclavian vein


There are three common sites of compression:

  • between the coracoid process and pectoralis minor muscle
  • between the 1st rib and collarbone
  • between the 1st rib, and anterior and middle scalene muscles


Causes and Risk factors:

A variety of things can lead to TOS, these include:

  • Poor posture – poor position of the thorax and shoulder blade can reduce the space around nerves and blood vessels, increasing the risk of compression
  • Jobs or sports involving repetitive overhead movements
  • Trauma, for example a crush injury, or fractures to the collar bone and/or first rib
  • Anatomical abnormalities of bone or soft tissue, for example an abnormally shaped collarbone


Signs and Symptoms

Common symptoms of TOS include:

  • Decreased sensation
  • Pain at rest
  • Reduced strength in the upper limb; possible loss of dexterity
  • Pain around the collarbone region which may travel down the upper limb
  • Upper limb may experience changes in temperature
  • Pain at night



Treatment primarily involves conservative treatment and may include:


  • Rest from aggravating activities
  • Mobilisation of thoracic and cervical spine, and 1st rib
  • Postural advice
  • Scapula stability exercises
  • Taping
  • Soft tissue massage to neck, back and shoulder region


Surgery may be advocated if conservative rehabilitation has failed.

To make an appointment for an initial physio assessment at our Wilmslow, Manchester, Altrincham or Wigan clinics, and discuss a treatment plan for your issue call Harris & Ross on 0161 832 9000 or click the book now icon below