From the Guidelines
Thoracic outlet syndrome (TOS) typically presents with symptoms such as pain, numbness, and tingling in the neck, shoulder, arm, or hand, particularly along the pinky finger and inner forearm, as well as weakness in the hand and arm muscles, and worsening symptoms when raising the arms overhead or carrying heavy objects. The symptoms of TOS can vary depending on which structures are compressed in the thoracic outlet, including the brachial plexus, subclavian artery, and/or subclavian vein 1. Common symptoms include:
- Pain, numbness, and tingling in the neck, shoulder, arm, or hand, particularly along the pinky finger and inner forearm (ulnar nerve distribution)
- Weakness in the hand and arm muscles, with difficulty gripping objects or performing fine motor tasks
- Worsening symptoms when raising the arms overhead or carrying heavy objects
- Swelling, discoloration, or coldness in the affected arm due to vascular compression
- Headaches at the base of the skull and neck pain
- Muscle wasting in the hand over time in neurogenic TOS (the most common type)
- Severe symptoms like blood clots, discoloration, or even gangrene in extreme cases of vascular TOS. These symptoms typically develop gradually but can be provoked by certain activities or positions that further compress the neurovascular structures in the thoracic outlet between the collarbone, first rib, and surrounding muscles 1. The costoclavicular triangle, interscalene triangle, and pectoralis minor space are the three distinct spaces that can be implicated in TOS, and narrowing of each space results in slightly different presentations due to differing severity of impingement on the transiting neurovascular structures 1.
From the Research
Symptoms of Thoracic Outlet Syndrome (TOS)
The symptoms of TOS can vary depending on the compressed structure(s) and can be classified as neurogenic, arterial, or venous. Some common symptoms include:
- Arm pain and swelling 2, 3, 4, 5
- Arm fatigue 2
- Paresthesias (numbness, tingling) 2, 3, 4
- Weakness 2, 3, 4
- Discoloration of the hand 2
- Upper limb pain 3
- Numbness or tingling that is exacerbated by shoulder or neck movement 3
- Pallor (pale skin) 4
Classification of TOS
TOS can be classified into three main forms: