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Thoracic Outlet Syndrome (TOS) is characterized by upper extremity pain or parasthesia caused from occlusion, compression, injury or irritation to the neurovascular structures traversing the thoracic outlet.

Most patients presenting with TOS are between the ages of 20-60, with a peak incidence in the fourth decade. TOS is more common in women with some estimates as high as 9:1.
Symptoms of TOS include: pain, parasthesias and motor weakness. Neck, arm and hand pain is often insidious in onset and aggravated by elevation of the arms or excessive head and neck movement. Pain and paraesthesia predominately involve the C8/T1 segmental level. (1) Symptoms follow an ulnar nerve distribution in 90% of cases. Motor deficits, especially diminished grip strength, are possible, but reflex changes are suggestive of more central pathology.

Benign mechanical compression of the neurovascular bundle (i.e. “neurogenic TOS”) is by far the most common cause of TOS, accounting for well over 95% of all cases. (2) TOS is subdivided into one of three primary sites of compression.

  • Scalene induced TOS occurs from compression of the neurovascular bundle between the anterior and middle scalene muscles.
  • Pectoral compression occurs beneath the pectoralis minor tendon.
  • Costoclavicular compression happens between the first rib and clavicle.

Successful management of TOS requires accurate identification of the primary site of compression. Watch this short video demonstrating 3 useful tests to help differentiate the origin of Neurogenic TOS.

Check out this ChiroUp Lay Condition Report that provides your patients with a clear description of TOS, including appropriate ADL’s and exercises- created and delivered in less than 20 seconds!

Download Condition Report


  1. Lindgren, 1997 K.A. Lindgren Conservative treatment of thoracic outlet syndrome: a 2-year follow-up Archives of Physical Medicine and Rehabilitation, 78 (4) (1997), pp. 373–378
  2. Fugate, Mark W.; Rotellini-Coltvet, Lisa; Freischlag, Julie A. (2009). “Current management of thoracic outlet syndrome”. Current Treatment Options in Cardiovascular Medicine 11 (2): 176–83. 


About the Author

Dr. Brandon Steele

Dr. Brandon Steele


Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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