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What is the Thoracic Outlet?
The Thoracic Outlet is a space between the rib cage (thorax), and the collar bone (clavicle) through which the main blood vessels and nerves pass from the neck and thorax into the arm. The nerves and blood vessels leave the neck between the two muscles (scalene muscles).

What is a syndrome?
A syndrome is a set of symptoms and physical findings that point to a certain diagnosis. All the symptoms and physical findings are not always present.
Various symptoms and physical findings may be present in different grades of severity.

What is Thoracic Outlet Syndrome?
Thoracic outlet syndrome is a combination of pain, numbness, tingling, weakness, or coldness in the upper extremity caused by pressure on the nerves and/or blood vessels in the thoracic outlet.

What Causes Thoracic Outlet Syndrome?
There are several causes of TOS. The common underlying cause of the syndrome is compression of the nerves and arteries of the arm in the Thoracic Outlet. In some cases the cause of compression is evident- an extra first rib or an old fracture of the clavicle, which reduces the space of the outlet. In other cases the cause is not clear. Compression may occur with repetitive activities that require the arms to be held overhead.

Symptoms
Symptoms of TOS include pain, numbness and tingling, (pressure on sensory nerves) weakness and fatigue (pressure on motor nerves) or swelling and coldness in the arm and hand (pressure on blood vessels). The symptoms can mimic many other conditions, such as a herniated disk in the neck, carpal tunnel syndrome, and even bursitis of the shoulder. Thus this syndrome can be very difficult to diagnose.

Treatment
When an anatomic defect is obvious that constricts the outlet, (an extra rib, a broken collar bone) surgery can correct the problem. This is rare. Good posture and overall conditioning are very important in treating the rest. The length of time the arms are used in outstretched or overhead positions should be reduced and spaced. Taking frequent breaks, changing positions, and stretching are useful. A physical therapist or an occupational therapist can teach the exercises. A home program of exercise is essential and must be performed consistently to produce benefits. Symptoms often respond to an exercise program addressing a healthy posture and muscle balance. Stretching and strengthening can help achieve optimal posture. Obese patients should seek advise for safe weight loss. A work site specialist can evaluate your workplace to determine safe alignment, work site postures, and work-related furniture. Women with large, pendulous breasts may benefit from a strapless long-line bra. Surgery for Thoracic Outlet Syndrome is the last resort.