Thoracic outlet syndrome

Thoracic outlet syndrome affects your upper body, such as your arms, hands, chest and neck.

Symptoms include:

  • pain in your neck, head, upper back, chest, shoulder, arm or hand
  • numbness in your arm, hand, or fingers on 1 or both sides of your body
  • pins and needles
  • weakness in your shoulder, arm or hand
  • difficulty raising your arm, or it makes symptoms worse
  • your arm feels tired or heavy
  • swelling in your arm and hand
  • your arm or hand feels colder, warmer, or sweats more than usual
  • your arm or hand turns blue, grey, paler than usual or blotchy (mottled, with a pattern that looks like lace) – this can be harder to see on brown and black skin

It’s important to get medical help if you have symptoms of thoracic outlet syndrome.

See a GP if:

  • you think you have thoracic outlet syndrome

Ask for an urgent GP appointment or get help from NHS 111 if:

  • your arm is painful or cramping, swollen, warm and red (but redness can be harder to see on brown and black skin)

These could be signs of a blood clot caused by thoracic outlet syndrome. A blood clot can be life threatening if it's not treated quickly.

You can call 111 or get help from 111 online.

Call 999 if:

You have thoracic outlet syndrome and:

  • sudden breathlessness
  • severe chest pain (this may be worse when you breathe in)

If you have symptoms of thoracic outlet syndrome, a GP will usually check your arms, chest and neck and ask you to do a range of movements to look for a possible cause of your symptoms.

They may refer you for tests, such an an X-ray or an ultrasound, CT or MRI scan of your chest and arms.

Some cases of thoracic outlet syndrome may be treated with:

  • physiotherapy – a physiotherapist can teach you some stretching and strengthening exercises that reduce pressure on squashed nerves
  • medicines – you may need medicines to help treat pain, relax muscles, improve circulation and reduce your risk of blood clots

Surgery may be recommended if:

  • your nerves are affected and physiotherapy has not helped
  • your blood vessels are affected and it's causing serious problems (such as a blood clot)
  • thoracic outlet syndrome is from an injury or a problem such as having an extra rib (cervical rib)

Thoracic outlet syndrome can happen if the nerves or blood vessels that pass through a small space at the top of your ribs (the thoracic outlet) become squashed.

Things that can lead to thoracic outlet syndrome include:

  • being born with an extra rib (known as a cervical rib), muscles or ligaments that make your thoracic outlet too small
  • poor posture
  • an injury to your chest, neck or ribs (such as a car accident)
  • jobs or activities that involve lots of repetitive arm movements (for example if you're a builder or do lots of swimming)
  • gaining a lot of muscle (for example, if you're a body builder)