Symptoms and Diagnosis of Chest Outlet Syndrome


Chest Outlet Syndrome (COS), also known as Thoracic Outlet Syndrome (TOS), is a condition that occurs when the blood vessels or nerves between the collarbone and the first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers. If left untreated, it can lead to more severe complications.

Illustration of a person suffering from chest exit syndrome symptoms.

Symptoms of Chest Outlet Syndrome

1. Pain and Discomfort

The most common symptom of Chest Outlet Syndrome is pain. This pain can be located in the neck, shoulder, and arm. It may also radiate into the fingers. The pain is often described as aching, sharp, or burning. For many, the pain worsens with specific activities, such as lifting objects or raising the arms.

Types of Pain

  • Neck Pain: Often starts at the base of the neck and radiates outward.
  • Shoulder Pain: Feels deep and can be mistaken for a shoulder joint problem.
  • Arm Pain: Travels down the arm, often leading to a feeling of heaviness.

2. Numbness and Tingling

Many patients experience numbness and tingling in their arms and fingers. This is due to the compression of the nerves in the thoracic outlet. The sensation may come and go, often worsening with certain activities or positions.

Common Areas of Numbness

  • Fingers: Particularly the ring and pinky fingers.
  • Forearm: May feel like pins and needles or a burning sensation.

Illustration showing areas of numbness in the fingers and arms common in thoracic outlet syndrome

3. Weakness in the Arms and Hands

Weakness in the hands and arms is another common symptom. Patients may find it difficult to grip objects or perform tasks that require fine motor skills. This weakness can result from prolonged nerve compression, leading to muscle atrophy over time.

Impact on Daily Activities

  • Gripping: Difficulty holding onto items like a phone or pen.
  • Lifting: Challenges in lifting objects, even light ones.
  • Fine Motor Skills: Struggles with tasks like buttoning a shirt or typing.

4. Swelling

Swelling in the arms and hands can occur, often accompanied by a feeling of heaviness. This can be due to the compression of blood vessels, leading to reduced blood flow and subsequent swelling.

Indicators of Swelling

  • Visible Swelling: Noticeable puffiness in the hands and forearm.
  • Heaviness: A sensation that the arm is heavier than usual.

5. Discoloration

Discoloration of the arm and hand, such as a bluish color, can occur when blood flow is significantly restricted. This is a serious symptom and requires immediate medical attention.

Signs of Discoloration

  • Bluish Tint: Often indicative of reduced oxygen in the blood.
  • Paleness: Can also occur, showing a lack of blood flow.

An illustration showing the signs of discoloration seen in thoracic outlet syndrome.

Causes of Chest Outlet Syndrome

1. Anatomical Defects

Some individuals are born with extra ribs (cervical ribs) or abnormally tight fibrous bands that compress the nerves or blood vessels.

Types of Anatomical Defects

  • Cervical Ribs: Extra ribs that can press on the thoracic outlet.
  • Fibrous Bands: Tight bands of tissue that restrict space.

2. Poor Posture

Poor posture, such as slumping forward or dropping your shoulders, can compress the thoracic outlet area and lead to symptoms.

Effects of Poor Posture

  • Forward Slumping: Increases pressure on the thoracic outlet.
  • Shoulder Dropping: Reduces space for nerves and vessels.

3. Trauma

Injuries from accidents or repetitive motion activities can cause inflammation and compression in the thoracic outlet.

Common Trauma Sources

  • Car Accidents: Sudden impacts can injure the area.
  • Repetitive Strain: Activities like typing or lifting can cause gradual damage.

4. Repetitive Activities

Repetitive activities that involve lifting your arms above your head can aggravate or cause symptoms of Chest Outlet Syndrome.

Examples of Repetitive Activities

  • Overhead Lifting: Common in construction or certain sports.
  • Typing: Prolonged keyboard use without proper ergonomics.

An illustration showing examples of repetitive activities that can cause thoracic outlet syndrome.

Diagnosis of Chest Outlet Syndrome

1. Physical Examination

A healthcare provider will conduct a thorough physical examination, checking for tenderness, swelling, or changes in color in the affected area. They will also assess your range of motion and strength.

Examination Techniques

  • Palpation: Feeling for tenderness and abnormalities.
  • Range of Motion Tests: Assessing mobility and pain response.

2. Medical History

Your medical history is crucial in diagnosing COS. The doctor will ask about any injuries, repetitive activities, or anatomical abnormalities.

Key Questions

  • Injury History: Details about past accidents or trauma.
  • Activity Levels: Information about daily and occupational activities.

3. Imaging Tests

Imaging tests such as X-rays, MRIs, or CT scans can help identify any anatomical abnormalities or injuries that may be causing the symptoms.

Types of Imaging

  • X-rays: Useful for detecting cervical ribs.
  • MRI: Detailed images of soft tissues.
  • CT Scan: Comprehensive view of the thoracic outlet.

4. Nerve Conduction Studies

Nerve conduction studies and electromyography (EMG) can be used to assess the electrical activity of your muscles and the speed of nerve signals.

Conducting Nerve Tests

  • EMG: Measures muscle response to nerve stimulation.
  • Nerve Conduction Velocity: Tests the speed of signal travel.

5. Provocative Tests

These tests involve specific movements or positions to reproduce your symptoms and help pinpoint the cause. The Adson’s test, Wright’s test, and Roos stress test are commonly used.

Common Provocative Tests

  • Adson’s Test: Arm extension and head rotation.
  • Wright’s Test: Arm abduction and external rotation.
  • Roos Stress Test: Arm elevation and opening/closing of fists.

Treatment Options

1. Physical Therapy

Physical therapy is often the first line of treatment. Exercises to strengthen and stretch the muscles around the thoracic outlet can relieve symptoms.

Therapy Techniques

  • Strengthening Exercises: Focused on the shoulder girdle.
  • Stretching Routines: To increase flexibility and reduce compression.

2. Medications

Pain relievers and muscle relaxants can help manage pain and discomfort.

Common Medications

  • NSAIDs: For reducing inflammation and pain.
  • Muscle Relaxants: To ease muscle tightness and spasms.

3. Surgery

In severe cases, surgery may be necessary to remove the source of compression.

Surgical Options

  • First Rib Resection: Removing part of the first rib.
  • Scalenectomy: Cutting the scalene muscles to relieve pressure.

An illustration showing surgical options for thoracic outlet syndrome.


Chest Outlet Syndrome can significantly impact your quality of life, but with proper diagnosis and treatment, symptoms can be managed effectively. If you experience symptoms of COS, it is essential to seek medical advice to prevent complications. Understanding the symptoms and diagnostic methods is the first step towards effective treatment and management of Chest Outlet Syndrome.

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