Thoracic Outlet Syndrome (TOS)

Thoracic outlet syndrome (TOS) is a condition where the nerves, arteries, and veins in the space between your collarbone and your first rib become compressed. This can cause pain in the shoulders and neck, numbness in the fingers, and weakness in the arms.

TOS is not very common, affecting only about 1 in 1,000 people. It tends to occur more frequently in women than men. TOS is a progressive condition, meaning it can get worse over time if left untreated. Without treatment, symptoms may become severe and disabling.


The goal of treatment for TOS is to relieve pressure on the compressed nerves and blood vessels. This can be done through non-surgical approaches or surgery. Treatment helps alleviate symptoms and prevent permanent damage.


Non-Surgical Treatments

Physical Therapy

Physical therapy can help improve posture, stretch tight muscles, and strengthen the shoulder girdle to take pressure off the thoracic outlet.


Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and inflammation associated with TOS. Muscle relaxers may also be prescribed.

Lifestyle Changes

Avoiding repetitive arm motions and maintaining good posture can help minimize compression. Weight loss may also decrease pressure on the thoracic outlet space.


Surgical Treatments


This procedure involves surgically removing a portion of the scalene muscles in the neck which compress the nerves and vessels. Removing the scalene muscles helps to open up space in the thoracic outlet region and relieve symptoms.

First Rib Resection

Our surgeons perform this surgery to remove a portion or all of the first rib, relieving compression. Sometimes, there are anatomic anomalies such as a “cervical rib” which needs to be removed.

Transaxillary First Rib Resection

This is an inpatient surgery performed at the hospital. Your surgeon makes an incision in the armpit area and removes a portion of the first rib, releasing any compressed nerves and vessels without any neck or chest incisions.

Pectoral Outlet Release Surgery

Our skilled hand surgeons can perform an open surgery to release the pectoralis minor muscle or other structures contributing to compression..

Why Patients Trust the Center for Hand & Upper Extremity Surgery

The Center for Hand and Upper Extremity Surgery is a beacon of hope for patients who believe that they have run out of options. Our state-of-the-art ambulatory surgical center is recognized as one of the top facilities in the country for the surgical and non-surgical treatment of thoracic outlet syndrome.

When to Seek Medical Attention

You should make an appointment with your doctor if you experience persistent numbness, tingling, pain, or weakness in the shoulders, arms, or hands. Seek prompt medical care if you suddenly lose strength or movement in an arm or hand, as this could indicate vascular compromise requiring emergency surgery. Don't ignore symptoms of TOS -early treatment provides the best outcome.

Frequently Asked Questions

What causes TOS?

TOS is often caused by physical structures like a cervical rib or tight scalene muscles compressing the nerves and vessels. Injuries, poor posture, obesity, and repetitive movements can also contribute to TOS.

What are the risk factors?

Women are more susceptible to TOS than men. Additional risk factors for TOS include jobs requiring repetitive arm motions, anatomical abnormalities, and previous collarbone fractures. Genetics may also play a role.

How is TOS diagnosed?

TOS is diagnosed based on a physical exam, patient history, and tests like x-rays, MRI, electrodiagnostic studies, and vascular studies.

What is the long-term prognosis after treatment?

With proper treatment, many patients see great improvement in their symptoms and quality of life. However, some mild symptoms can linger even after successful surgery.

Can TOS be prevented?

While you can't prevent all causes of TOS, maintaining good posture and shoulder girdle strength may help avoid compression in some cases.

HUES Surgeons

Don't live with the discomfort of thoracic outlet syndrome. Get the answers you need.