Do You Have Thoracic Outlet Syndrome (TOS)?

Illustration of Thoracic Outlet Syndrome

Thoracic outlet syndrome & carpal tunnel syndrome have nearly identical symptoms.

That's why both patients & doctors often confuse the two conditions.

Carpal tunnel syndrome affects about 1 in 20 people.
Thoracic outlet syndrome affects about 1 in 50 people.

It's important to know which condition is affecting you because their treatments are completely different.

Given that carpal tunnel is much more common, FIRST take the carpal tunnel self-test. If your results are unclear, come back & take the self-tests for thoracic outlet below.

They're the same tests your doctor uses in their office to diagnose TOS.

These are the symptoms of thoracic outlet syndrome. You can have 1 or more of them.

Numbness or tingling in your arm or fingers
Weakening grip
Pain or aches in your neck, shoulder or hand
Muscle wasting in the fleshy base of your thumb
Discoloration of your hand (bluish color)
Arm pain and swelling
Blood clot in veins or arteries in your upper body
Lack of color in any fingers or your entire hand
Weak or no pulse in the affected arm
Cold fingers, hands or arms
Arm fatigue with activity
Weakness of arm or neck
Throbbing lump near your collarbone

Verify you have Thoracic Outlet Syndrome
by taking these 5 simple, fast & accurate tests:

Test 1: Elevated Arm Stress Test

You can stand or be seated. Raise both arms with your elbows positioned a little behind your head. Slowly open and close your hands for 3 minutes.

Positive sign for thoracic outlet syndrome: heaviness, pain or intense numbness or weakness in your arms; tingling or pins-and-needles in your hand.

Test 2: Adson (or Scalene Maneuver)

Stand up for this. Your helper finds your radial pulse. It's felt below your wrist on the thumb side. While your helper is monitoring your pulse, drop your arm to a 45 degree angle. Then rotate your head toward the tested arm. At the same time, tilt your head backwards to extend your neck while the helper extends and holds your arm.

Positive sign for thoracic outlet syndrome: disappearance of your radial pulse.

Adson test Thoracic Outlet Syndrome (TOS)

Test 3: Costo-clavicular Maneuver

Sit down. Your helper locates your radial pulse again. Then the helper pushes your shoulder down and pulls your arm back a little as you lift your chest in an exaggerated “at attention” posture.

Positive sign for thoracic outlet syndrome: absence of your radial pulse.

(This test is usually positive if you have symptoms while wearing a heavy jacket or back-pack.)

Costo-clavicular Maneuver

Test 4: Allen Test

While you’re seated, the helper locates your radial pulse again. The helper flexes your elbow to 90 degrees while your upper arm is extended horizontally and rotated backward. Then turn your head away from the tested arm.

Positive sign for thoracic outlet syndrome: if your radial pulse disappears as you rotate your head.

Test 5: Provocative Elevation Test

Stay seated and cross your arms. Your helper grasps both arms by the elbows. Remain passive and let the helper fully elevate both shoulders in a forward position. Hold this position for 60 seconds.

(This will normally increase your pulse & hand temperature.)

Positive sign for thoracic outlet syndrome: feelings go from numbness to pins-and-needles or tingling, or you feel some pain; it also might feel like when your arm “falls asleep” and circulation returns.

How'd you do?

If you answered "no" to ALL of the above questions, then your symptoms may be due to carpal tunnel syndrome or tendonitis. Click here to jump to the carpal tunnel self-test.

If you answered "yes" to 1 or more of the above questions, then it's likely you have thoracic outlets syndrome.

What next? If you have TOS, then you have 3 treatment options to relieve symptoms.

1) Physical therapy: The most common initial treatment for thoracic outlet syndrome is physical therapy. Physical therapy increases the range of motion of the neck and shoulders, strengthens muscles and promotes better posture. Most patients experience an improvement in symptoms after undergoing physical therapy.

2) Medications: For pain relief, over-the-counter pain medications, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin), are recommended by doctors. Your doctor may also prescribe a muscle relaxant for additional pain relief.

3) Surgery: In some cases, surgery may be necessary. HOWEVER exhaust your physical therapy options first. Surgery is a messy business involving mutilation of your ribs and muscles.

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