Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a disorder that involves the compression of a nerve bundle (brachial plexus) and associated blood vessels as they travel from the neck through or near to the narrow space known as the "thoracic outlet" found between the collarbone (clavicle) and the first rib. Compression at or near the thoracic outlet can be caused by pressure from bones, ligaments or other soft tissues on the nerve bundle and/or blood vessels.  


The Three Types of Thoracic Outlet Syndrome: 

Neurological Thoracic Outlet Syndrome 
This is the most common category of thoracic outlet syndrome and is characterized by impingement and irritation of the nerves of the brachial plexus. The brachial plexus is the nerve bundle that travels from the cervical spine (neck) to the arms where it supplies the arms and hands with motor and sensory function.  

Vascular Thoracic Outlet Syndrome 
This type of thoracic outlet syndrome is brought on when veins and/or arteries traveling through or near to the thoracic outlet become compressed and blood circulation to the arm is inhibited. 

Non-Specific Type of Thoracic Outlet
Also known as “disputed thoracic outlet syndrome”, is indicated when there is unexplained arm, posterior (back of the) shoulder or neck area pain.  Symptoms usually begin after a trauma such as a motor vehicle accident. 

Symptoms of Thoracic Outlet Syndrome

Symptoms are most often those of nerve irritation and include:

  • Pain, particularly in the inner aspect of the arm, forearm, and the ring and small fingers.

  • Numbness and/or pain often at night, in many cases it is severe enough to cause sleep disturbances.  

  • The numbness and/or pain often involves all 5 fingers but usually it is most noticeable in the ring and small finger and on the small finger side of the forearm.

  • Weakness of the neck, chest and arms .

  • Cold intolerance to the affected area.

  • Neck pain, pain over the shoulder and chest.

  • Swelling of the affected arm and hand.

Causes of Thoracic Outlet Syndrome 

Repetitive strain 
Repeatedly performing the same task(s) such as typing, hold the phone with your shoulder while talking, lifting objects overhead or performing athletic movements like pitching can put one at risk of compressing the nerves and or vessels traveling through the thoracic outlet. 

Poor Posture 
Slumping posture with shoulders rolled or head held forward could cause compression in thoracic outlet. 

A traumatic event like a car crash that has lead to a collarbone break can also be a cause of thoracic outlet syndrome. 


In Traditional Chinese Medicine all three types of thoracic outlet syndrome are considered a blockage syndrome, due to the blockage of the blood vessels and motor and sensory nerves that supply the arm and hand. Treatment approach for thoracic outlet syndrome involves a neck and shoulder assessment followed by a combination of acupuncture, and one or more of the following therapies: soft tissue massage, Kinesiology taping, Chinese herbal medicine and stretching techniques. 

To book a treatment session or a free 15 minute assessment Click Here

Ryan Samuels - Registered Acupuncturist & Chinese Herbalist 



Dutton, Mark, Dutton’s Orthopaedic Examination, Evaluation and Intervention (McGraw-Hill Companies, 3rd ed, 2012)


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