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Thoracic outlet syndrome

Syndroma aperturae thoracis superioris · Syndrom horní hrudní apertury

What it is

Nerves or vessels to the arm squeezed between the collarbone, first rib and scalene muscles — by posture, an extra neck rib or repetitive overhead work.

Symptoms & signs

  • Pain and tingling down the inner arm into the little finger
  • weak, tiring hand
  • worse with the arm raised
  • swollen blue arm (venous form)
  • cold pale hand (arterial form)

🚩 Get help if…

  • call 112 / 911 now Sudden swelling and blue colour of one arm — possible clot
  • call 112 / 911 now Cold, white, painful hand or fingers
  • see a doctor soon Wasting of the hand muscles
  • see a doctor soon Arm pain or numbness getting worse

Where it strikes

Medical treatment

  • Examination and imaging, including for a neck rib
  • physiotherapy for posture and scalene stretching
  • clot-busting and anticoagulation for a venous clot
  • first-rib resection and scalenectomy

Natural & lifestyle

  • Posture work and breathing exercises
  • no heavy shoulder bags
  • weight loss

Emerging & experimental

  • Botulinum toxin into the scalenes
  • robotic first-rib resection

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Yoga and breathing retraining — small studies early / small studies
  • Massage — helps some mixed evidence
  • Chiropractic first-rib mobilisation — anecdotal anecdotal / traditional

ICD codes