Thoracic Outlet Syndrome

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Thoracic outlet syndrome occurs when the blood vessels and nerves under the collarbone that travel to the arm are compressed between the collarbone and the first rib. 


You can develop thoracic outlet syndrome through the natural formation of your anatomy, though symptoms may not appear for decades.

Other causes include:

  • Trauma to the shoulder or collarbone area
  • An extra rib above the first rib
  • Abnormally tight fibrous band (ligament) that connects the spinal vertebra to the ribs

Risk Factors

Extra pressure on the nerves and blood vessels near the collarbone can be a result of:

  • A long, muscular neck
  • Droopy shoulders 
  • Poor posture


You may have thoracic outlet syndrome if you experience these symptoms:

  • Pain, numbness and tingling in the last three fingers and inner forearm
  • You repetitively extend your arms over your head or your arm turns pale when lifted.
  • Weakness and fatigue in the forearm and hand muscles, particularly when doing something with your arms over the head like washing your hair
  • Pain and tingling in the neck and shoulders, which may worsen if you carry something heavy

Treatment at UVA

Our specialists can diagnose your tests including:

  • X-ray
  • Upper extremity blood pressure evaluation
  • Magnetic resonance imaging (MRI)
  • Electromyography

Your doctor may suggest physical therapy or surgery to alleviate the pressure and compression of the artery or nerves. Surgery may require removal of the first rib and the constricting bands and muscles.

If your problem is a result of a previous collarbone fracture, your doctor may remove your collarbone. A bypass may be required to reconstruct the artery if it's been compressed for a long time or is permanently injured.

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.