When to Seek Care for Chronic Shoulder Pain and Other Thoracic Outlet Syndrome Symptoms

Don’t raise your hand if you are curious about thoracic outlet syndrome symptoms—it might hurt too much. In addition to this type of shoulder problem, patients with thoracic outlet compression may also experience other warning signs (in their necks, upper backs, arms, elbows, or fingers) that something isn’t right.

Because the symptoms of thoracic outlet syndrome (TOS) can be similar to other, more common conditions, such as rotator cuff tears and carpal tunnel syndrome, evaluation and treatment by a shoulder specialist is essential to ensure you get an accurate diagnosis and receive expert care.

Read on to learn how thoracic outlet syndrome symptoms differ from other shoulder injuries and conditions, and find out why it’s critical to diagnose TOS as soon as possible.

What Is Thoracic Outlet Syndrome?

The thoracic outlet is the space where the nerves and blood vessels exit the neck and thorax and enter the arm. TOS occurs when the nerves and/or blood vessels become compressed.

The primary symptom is a dull pain when raising the arms or performing overhead motions. However, pain, numbness, weakness, and tingling can extend from the neck to the fingers, depending on the location and duration of the compression.

Thoracic outlet syndrome causes include an abnormal first rib, whiplash, falls, and repetitive overhead arm motions during work or sports, which can result in inflammation, swelling, or injury.

TOS affects the quality of daily life. You may notice thoracic outlet syndrome symptoms while performing these routine tasks:

• Reaching overhead
• Holding your arms overhead for an extended period
• Typing
• Writing
• Lifting
• Brushing your hair

Risk factors include demographics and lifestyle. These populations are at the highest risk of thoracic outlet syndrome:

• Women
• Athletes in baseball, swimming, tennis, volleyball, diving, lacrosse, and weightlifting.
• Healthcare professionals
• Construction workers
• Manufacturing workers
• Manual laborers
• Hairdressers
• Mechanics

Types of TOS

There are three classifications of thoracic outlet syndrome, and the specific symptoms vary. The following types are listed in order of commonality:

• Neurogenic thoracic outlet syndrome
• Venous thoracic outlet syndrome
• Arterial thoracic outlet syndrome

Neurogenic

Neurogenic TOS accounts for 90% of all cases. Caused by a compression on a nerve, it presents with a large range of thoracic outlet syndrome symptoms, and they can be longstanding, sometimes for years, while other conditions are ruled out.

Venous

Venous thoracic outlet syndrome is caused by compression of a vein. It is characterized by sudden and extreme swelling of the arm or fingers. It’s often accompanied by skin turning blue, as well as pain, heaviness, and noticeable veins. Longstanding cases may present neurogenic thoracic outlet syndrome symptoms, too. One common cause of venous TOS is a blood clot in the vein under the clavicle.

Arterial

Arterial thoracic outlet syndrome is caused by a compression of an artery, reducing blood flow to the arm and fingers. The main symptom is pain in one arm, possibly radiating to the hand. It can also cause numbness, tingling, and discoloration. Blood clots can be both a cause and a complication of arterial TOS.

Thoracic Outlet Syndrome Symptoms

Thoracic outlet syndrome pain can take many forms, depending on the location of the compression, the severity, and how long it has persisted. Here are some of the most common signs, organized by area on the body:

• Shoulder, upper back, and/or shoulder blade: Pain
• Neck: Stiffness
• Elbow: Pain, numbness, tingling
• Arm and/or hand: Pain, numbness, tingling, weakness, swelling, coldness, and skin discoloration
• Fingers: Numbness, tingling, Raynaud’s phenomenon (discoloration of white, blue, or red caused by cold or stress)

Patients with TOS may also experience headaches. They may also notice that their symptoms of thoracic outlet compression increase when making overhead motions or that their problems improve after resting.

Thoracic Outlet Syndrome Causes

Some thoracic outlet syndrome symptoms can be linked to rib abnormalities you’re born with and never know you have. That said, it’s more common for TOS to develop from trauma, like whiplash, experienced during car accidents (with symptoms sometimes appearing months later), or as a result of poor posture or repetitive motions that compress the thoracic outlet. Muscular individuals—especially those who participate in sports or strength training that build large neck, back, and shoulder muscles—may also be predisposed, as increased muscle mass in this area can contribute to compression.

Some examples of activities involving repeated movements that can cause thoracic outlet compression include:

• Carrying or lifting heavy items
• Sustained awkward posture
• Sleeping on your stomach or side with arms overhead or under a pillow
• Overhead movements in swimming, baseball, tennis, or painting, etc.

Thoracic Outlet Syndrome vs. Other Conditions

Thoracic outlet syndrome symptoms overlap with signs of other nerve entrapments, such as carpal tunnel syndrome (numbness and tingling in the hand and fingers) and cubital tunnel syndrome (pain and numbness in the arm and hand).

TOS also presents like cervical radiculopathy (pain, numbness, and weakness in the arm, shoulder, or hand), rotator cuff tears (shoulder and arm pain), and fibromyalgia (widespread pain in the shoulder and arm). The list is long.

Thoracic outlet syndrome is more likely to cause swelling, discoloration, cold, and weakness in the arm or hand than the conditions mentioned above.

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⚠️ Seek immediate medical attention if you experience sudden arm swelling, skin color changes, near-complete loss of function, and severe cold or weakness, as these symptoms may be signs of arterial damage or blood clots.

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The similarities between thoracic outlet syndrome and other upper-extremity conditions can make an accurate diagnosis challenging, while you suffer from poor sleep quality and work performance. Seek immediate medical attention if you notice sudden arm swelling, skin color changes, a near-complete loss of function, and severe cold or weakness. These could be signs of arterial damage or blood clots.

Why TOS Benefits From Specialized Care

Compared to primary care doctors, shoulder specialists have the experience and knowledge to reach an accurate diagnosis of thoracic outlet syndrome symptoms more quickly, leading to quicker pain relief and reducing the chances of long-term complications like stroke.

How Is Thoracic Outlet Syndrome Diagnosed?

Diagnosing thoracic outlet syndrome is typically made based on an aggregate of medical history, recent imaging, new imaging, and TOS-specific physical examinations.

In most cases, a shoulder specialist will begin with a thorough medical evaluation, including a review of your medical history (including exposure to thoracic outlet syndrome risk factors) and a conversation about any previous tests and treatments you’ve received to treat shoulder pain.

Your shoulder doctor will do a variety of specialized tests, raising your arm to assess for thoracic outlet syndrome.

Thoracic Outlet Syndrome Treatment

Physical therapy and pain management are the first options to treat thoracic outlet syndrome symptoms. These non-invasive courses of treatment often lead to significant improvement in a few weeks to a few months. Occasionally, surgery is necessary to relieve the compression in the thoracic outlet. Recovery can last up to a year before regaining maximum function. Many patients recover completely from TOS.

Choose the Shoulder Experts at IHTSC

When a shoulder condition, like TOS, is challenging to diagnose, expertise is crucial to ensure a proper diagnosis and the most complete recovery possible. The esteemed medical team at Indiana Hand to Shoulder Center specializes in the most challenging cases. Many of our patients find lasting relief from thoracic outlet syndrome symptoms that other physicians couldn’t solve. 

If you are experiencing chronic shoulder pain or other potential signs of TOS, IHTSC’s shoulder pain relief experts can help. Call us at 317-743-3985 to schedule a consultation or schedule an appointment online.

You Might Also Like:

• Don’t Shrug Off Joint Pain: Shoulder Inflammation Can Signal a Serious Problem
• Brachial Plexus Trauma: When Your Arm and Hand Stop Talking to Your Brain
• Why Does My Arm Hurt? Can I Get Arm Pain Relief?

Reviewed by Dr. Greg Merrell and Dr. Brandon Smetana