Thoracic Outlet Syndrome – Bromley Sports Injury Clinic

Key Points

Thoracic Outlet Syndrome (TOS) is caused by compression of nerves or blood vessels as they pass from the neck into the arm.
Symptoms include arm tingling, numbness, weakness, or circulatory changes (coldness, colour change).
It may be triggered by posture, lifting, or overhead activity.
At Bromley Sports Injury Clinic, we assess posture, biomechanics, and nerve function to guide personalised treatment.

What is Thoracic Outlet Syndrome?

The thoracic outlet is the narrow space between the collarbone and first rib.

Nerves (the brachial plexus) and blood vessels pass through this space to the arm. If compressed, it causes neurological or vascular symptoms.

TOS can be:

Neurogenic TOS – nerve compression (most common)
Venous TOS – vein compression causing swelling, discolouration
Arterial TOS – artery compression causing coolness, weakness

Symptoms

Tingling, pins and needles, or numbness in the arm/hand
Weakness or clumsiness in the hand or grip
Aching pain in neck, shoulder, or arm
Symptoms worse with arms overhead or carrying weight
In vascular TOS: arm swelling, coldness, or colour change

Causes & Risk Factors

Poor posture (rounded shoulders, forward head)
Repetitive overhead work or sports (swimming, throwing, weightlifting)
Carrying heavy loads (backpacks, bags)
Trauma to the collarbone or shoulder
Anatomical variations (extra rib, tight scalene muscles)

Diagnosis at Bromley Sports Injury Clinic

Because TOS symptoms overlap with other conditions, an accurate diagnosis is key.

Osteopathic assessment – posture, shoulder mobility, nerve provocation tests
Differential diagnosis – excluding cervical radiculopathy, carpal tunnel, or shoulder impingement
Diagnostic ultrasound – not for thoracic outlet itself, but to rule out soft-tissue causes at the shoulder/elbow if suspected
Referral – vascular studies if circulation is affected

Self-Help

Correct posture (especially for desk workers and drivers)
Avoid carrying heavy bags on one shoulder
Stretch chest (pectorals) and neck muscles
Strengthen upper back (scapular stabilisers)
Take breaks from repetitive overhead activity

Treatment Options at Bromley Sports Injury Clinic

✅ Osteopathic treatment – mobilisation, postural correction, soft tissue therapy
✅ Exercise rehabilitation – strengthening scapular and shoulder stabilisers
✅ Nerve gliding exercises – to reduce neural irritation
✅ Ergonomic and lifestyle advice – posture, desk setup, activity modification
✅ Referral – for vascular or surgical review in resistant cases

Prevention

Maintain upright posture with strong back and shoulder muscles
Use both shoulders when carrying bags
Stretch chest and neck regularly
Avoid prolonged overhead activity without breaks
Early assessment if tingling, weakness, or vascular changes appear

FAQs – Thoracic Outlet Syndrome

Q: How do I know if my symptoms are TOS or a pinched nerve in the neck?
Cervical radiculopathy often causes dermatomal symptoms, while TOS worsens with overhead postures. We test both to confirm.

Q: Is TOS dangerous?
Most cases are neurogenic (nerve compression), but vascular cases with swelling or colour change require urgent assessment.

Q: Can exercise fix TOS?
Yes. Postural strengthening and chest/neck stretching are key parts of treatment.

Q: Do I need surgery?
Rarely. Surgery is considered only in severe vascular or resistant neurogenic cases.

Book Your Appointment

Don’t ignore tingling, weakness, or circulation changes in your arm. Book a thoracic outlet syndrome assessment in Bromley today for clarity and effective treatment.

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