Thoracic Arthritis | Thoracic Outlet Syndrome | Disc Bulge | Disc Protrusion. | Muscle Strains | Rib Joint Displacement

Thoracic Arthritis

Thoracic outlet syndrome (TOS) occurs when the blood vessels or nerves in the space between your collarbone and first rib (thoracic outlet) are compressed. This can cause pain in your neck and shoulders, as well as numbness in your fingers. TOS is often caused by physical trauma from a car accident, repetitive injuries from your work or sport, certain anatomical defects (such as having an extra rib), and pregnancy. The most common types of TOS include:

  • Neurogenic (neurological): This is the most common type, characterised by compression of the brachial plexus (the network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand).
  • Vascular:  occurs when one or more of the veins (venous TOS) or arteries (arterial TOS) under the collarbone are compressed.
  • Nonspecific (also known as disputed): those with nonspecific-type thoracic outlet syndrome have chronic pain in the area of the thoracic outlet that worsens with activity, but a specific cause of the pain cannot be determined.


Depending on the type of thoracic outlet syndrome and which structures are compressed, symptoms may vary.

For neurological TOS:

  • Muscle wasting in the fleshy base of your thumb
  • Weakening grip
  • Numbness, tingling or altered sensation in your arm and/or fingers
  • Pain or aches in your neck, shoulder or hand

For vascular TOS:

  • Discolouration of your hand (typically bluish) 
  • Lack of color (pallour) in one or more of your fingers or your entire hand
  • Weak or absent pulse in the affected arm
  • Cold fingers, hands or arms
  • Numbness or tingling in your fingers
  • Weakness of arm or neck and arm fatigue with activity
  • Throbbing lump near your collarbone
  • Arm pain and swelling

What might a treatment plan look like?

Treatment for thoracic outlet syndrome usually involves physiotherapy and pain relief measures. 

The first week may include 1-2 sessions of physiotherapy, progressing to weekly sessions for 4-6 weeks and follow-up reviews as required. Hydrotherapy is valuable in the acute phase when gentle movement is required if land-based activity is not tolerated.

Most people improve with these approaches but in some cases, your doctor may recommend a referral to a specialist to see whether surgery is required.

Which of our team members works with thoracic outlet syndrome?

All of our physiotherapists

Thoracic Outlet Syndrome

Disc Bulge

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Disc Protrusion

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Muscle Strains

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Rib Joint Displacement

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