Thoracic outlet syndrome


  • Symptoms from compression of neurovascular bundle at thoracic outlet
  • Neuro complications most common (95%), then venous compression (3%), and then arterial (1%)
  • Scalene triangle most often involved area: borders are anterior scalene, middle scalene and first rib

Clinical Features

  • Pain, numbness or weakness in upper extremity aggravated by elevating hands
    • Neck rotation, arm abduction or UE external rotation may elicit symptoms
  • Sensory deficits common along T1 distribution
  • Swelling, claudication pain & cyanosis with activity if venous compression
  • Hand ischemia (pain, pallor, paresthesia, cold) if arterial compression
    • Almost always has cervical/anomalous rib
  • May have tender scalene muscles
  • Thrombus may develop from vascular compression

Differential Diagnosis

Shoulder and Upper Arm Diagnoses



Refered pain & non-orthopedic causes:


  • CXR
  • Consider duplex ultrasound if venous/arterial compression suspected


  • Physical therapy as outpatient
  • Treat embolus if present
  • Consider interscalene injection


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