Thoracic Outlet Syndrome Explained

Thoracic Outlet Syndrome is a really confusing subject because it may refer to any of 5 distinct entities. This video will outline explain each type (Traumatic / Symptomatic / Arterial / Venous / True Neurogenic Thoracic Outlet Syndrome) and their respective treatment. As always - I'm happy to answer general questions relating to this topic over here (questions relating to other conditions should be posted with their respective video). I also respectfully request that avoiding asking questions regarding to your own individual symptoms / diagnosis / treatment as I can't assist in this way.

[@williamgunter9186]

Dr. Simon this is the most helpful, professional, and explained video I have found. Years and years of research and this covers everything! 14 min in was best explanation for me but the whole video is brilliant! THANK YOU BROTHER!

[@hwsadberry6781]

For 11 or 12 years now I have been dealing with issues, that only this night, I have found the symptoms to fit TOS according to Mayo Clinic website. I thought I was alone and my Doctors have not been able to figure it all out. Carpal Tunnel release on my left elbow and hand have had little to no effect other than costing me a lot of money. Thank you for this video and explaining in a way I can easily follow. I have hope.

[@jessmontgomery4356]

Hello. I was diagnosed with TOS in 2003 having my first rib removed on the left side. Unfortunately it did not help me and has since caused me pain 24/7. Can you please tell me what type of problems this causes? Im having bad serious problems with my muscles joints nerves bones etc.

[@elzabethmcarthur3154]

Thank you. My GP just informed me I have this, it explains so much, I didn't take much of what she said in, so this is very helpful, thank you.

[@glee_again2594]

Very clear explanation and helped me confirm based on symptoms and physical therapist that I’m indeed in the true neurogenic TOS category. For now my physical (physio) therapist is working to open the area where the clavicle bones are. Another practitioner is using the Activated Release Technique to help the pecs and scalenes which are caught up. I have gentle stretches and a few strengthening exercises mostly targeting the scapulars. The PT figured it out after I was having confusing hand nerve symptoms that had my GP and orthopedic hand specialist confused, as well as a PT/OT for hands! You clearly helped explain why. I am already noticing more time of hand/forearm relief after treatments. I use a soft back straightener supporter during certain activities so that I don’t get caught all scrunched in forward during certain day time activities. I don’t depend on it, rather it’s a bit of a help at times when I’m in particular pain and find it more challenging to hold myself in a proper position. I sincerely appreciate your sharing this info. PS I’m 48 and once my PT suspected the NTOS, I looked up the symptoms and all of the puzzle pieces started connecting! My neck bilaterally and my right shoulder down back of arm felt weak and painful. I went to PT for that first. Then I thought I had DeQuervain’s, then carpal tunnel (received cortisone injections at the hand/wrist that didn’t help. Next my ulnar nerves were causing lots of pain. That thumb pad area is pain is what threw them all off as well. Formerly when I would rarely get it nerve flossing seemed helpful. But this became more chronic. At least I didn’t say yes to hand Surgery! It wasn’t the culprit (wrist/elbow), rather coming from up higher on my body. Knowledge is power and I am determined to get well as much as it depends on me. 🙏🙏🙏

[@threestain]

Excellent summary. Will watch carefully later. See and treat a large number of these and always must go hand in hand with the NeuroPhysiologists!

[@justinfuentes]

Thank you Dr. Simon, I appreciate you so much for this information!

[@schuftiandmunchkin]

Fantastic explanation. Really well done!

[@a.zo.3791]

חזק וברוך. תודה רבה רבה! The presentation is excellent

[@pmfg875]

Hello! I have bilateral cervical ribs that I have been told are interfering with the mechanics of my neck and arms. Thanks for helping with explaining it.😊

[@meimei10100]

There was a case of this with a small boy in the series that was set in Casualty 1900’s by the BBC . It was based on The Royal London and it’s portrayal of early studies of Neurology . True story as they had access to The Royal London hospital medical history.

[@Seeker794]

Leaning more in the tos direction after many dead ends. Mid trap excercises, thoracic extension, and pectoralis stretching are things i need to do to open up the outlet but these excercises also trigger symptoms, sometimes complete numbness in both arms. Muscle fatigue when im otherwise strong and reasonably fit, keeps activity low. Especially over head and reaching.

[@Siva-vh5sl]

Excellent presentation! Thank you!

[@natashaoz6502]

Brilliantly explained. Thank you. I have had a double mastectomy and my surgeon said I may have TOS. 🇦🇺 Natasha

[@justerinthings9686]

I'm Australian too 🙏 Bilateral VTOS

[@artbunker]

I believe i have this issue . The doctors will not believe me. m asking fora second opinion. I have had pain and tingling. Even my Chario believes i have TOS. How do i convince my doctors I have it ? They dont seem to care

[@justerinthings9686]

Very well explained! I am Bilateral VTOS. My right side (non-dominant) was so severely damaged, I had a stent implanted Xmas eve 2019. 🇦🇺🇦🇺 I was a gymnast for 10 years, then heavily into swimming, netball and now softball (12 years and counting).

[@silverfullbuster9177]

Were you doing these sports before or after

[@richardeadon6396]

Very good video, thank you. Nice drawings.

[@tonydonovan1311]

I have it on my sides of my throat. However not many has that problem and there no video how to fix it=(

[@captainbuggernut9565]

I have been referred to a vascular surgeon for investigations of TOS. I have burning and pain in the upper arm. Pins and needles in my left hand with numbness when I lie down on my left. Dizziness and tinnitus as well with a pain in the centre of my chest at the top and pain in my shoulder and collar bone area. I had a conductive nerve study which found the nerves seemed to work ok in left arm, forearm down. The chap suggested referral for vascular investigation with an upper body ultrasound and addsons tests. My gp says he doesn't think they do upper body ultrasound? I should add to get here I've had blood tests, xrays, three mris, spine, neck and brain. I was found to have mild scoliosis which I'm told is not thought to be connected. Any ideas would be good. I should add these symptoms seem to be accumulating. I started with just chest pain two years ago which was initially thought to be costochondritis.

[@humbertofernandes2287]

Is it possible that the act of swallowing causes pain in the chest and that this pain is related to tense muscles caused by poor posture?

[@matthewbinder1]

Thanks for such an informative video. It's the best explanation of all the different types of TOS I've come across. I have recently been diagnosed with a frozen right shoulder for which I'm receiving treatment. I've also received a somewhat controversial diagnosis of internal jugular vein stenosis whereby on the right (same side as frozen shoulder) the jugular is being severely compressed between the styloid and transverse process of the C1 vertebrae. Now TOS has been mentioned. I have a positive response to the Morley and Roo tests plus other relevant symptoms. I just wondered if you saw a high prevalence of frozen shoulder and/or IJVS with TOS in your clinic?

[@DrSimonFreilich]

Hi Matthew, very rare in my clinics (might be different for vascular colleagues) and I haven't come across it. Bw Simon

[@jamest7539]

I had the extra rib in my right shoulder removed in 2008. Feels like I have a golf ball sized lump behind the collarbone and it hurts constantly. Wish I knew if am going to drop dead from it or not to worry

[@silverfullbuster9177]

Didnt quite understand the last sentence.

[@HermesHeals]

I’m a painter and I’m pretty sure this is what I have and it is being mis diagnosed. First they told me it was dislocated rib, now I can barley use my right arm. It is also causing headaches and shooting pain into my face neck and head. Is this all common?

[@augustbramming4926]

I got carpal tunnel surgery, and it didnt work. I think i have this

[@gholamsultani7169]

I have been suffering from thoracic outlet syndrome for three years, and two weeks ago I was diagnosed with sonography. Do you think I need surgery?

[@visuallstuff]

thank you

[@joshs2444]

Do you know if Thoracic Outlet Syndrome cause POTS/Dysautonomia? Great video by the way.

[@DrSimonFreilich]

Thanks Josh! No it doesn't. Bw Simon

[@scotts2783]

Hi could I book an appointment to come and see you ?

[@lindan728]

Thank you I've been suffering with wasting in my thumb and pinky pain and numb, arm pain numbness. Not one out of four neurologist have any answers! Every test in the world neg. But I do have cervical rib spikes. Ty! Now to convince them. Lol

[@silverfullbuster9177]

Are you planning on getting the surgery

[@lindan728]

@@silverfullbuster9177 no it's not carpel tunnel so there's no surgery to help me.

[@Tajjy3]

@@lindan728 Hey Linda, check out Kjetil 'msk neurology' on KZbin and his website . He may be able to help you out, has definitely been able to reduce my symptoms.

[@carlitah2198]

Could a person have a brachial plexus Injury AND ntos. If a traumatic injury causes an injury to the Plexus is that a mechanism of injury that can cause ntos or do they co-occur independently? Would electro diagnostic tests be reliable in differentiating the diagnosis once axonal loss? 19:18 I’m under advisement of a physiatrist, but my only directive was “try to keep the function you have” one type indicates rest, the other indicates aggressive rehab. 14 months post traumatic injury. Thanks for making this content, I am using it to try to ask relevant questions about effective treatment.

[@DrSimonFreilich]

Hi Carlita, these are two very different types of issues occurring in the same region with different outcomes and treatments. Most traumatic injuries will be managed via rehab and sometimes surgery, but most true nTOS will require surgery as its a progressive problem. Bw Simon

[@ButAPasserBy]

Is this condition hereditary? My mother and I have both been diagnosed with TOS same symptoms, numbness and tingling in the outer three fingers with weakness of the thumb and index finger. We have both been seeking nonsurgical treatment with chiropractic, physical therapy and massage therapy.

[@DrSimonFreilich]

Hi not as far as I'm aware, but carpal tunnel is :)

[@ButAPasserBy]

@@DrSimonFreilich we both have issues with the 1st and second rib being pulled under the scapula and sticking together out of place, if that makes sense? And the scalen muscles tighten and cause the TOS... as I understand the explanation. We both have the issue on the Left side.

[@DrSimonFreilich]

Genuinely, really recommend you see a medical specialist, in your case, an Orthopaedic doctor specialising in shoulders. TOS is overdiagnosed by community based therapists. Whether or not you have it, I can't comment, but let me know down below what eventuates once you get your electrodiagnosis. Bw! Simon

[@RossiGucci]

Good afternoon, doctor, can you tell me if the thoraxic syndrome can cause dizziness or problems of pre-perception

[@DrSimonFreilich]

Hi, not as far as I'm aware. Bw Simon

[@RossiGucci]

@@DrSimonFreilich não entendi a sua resposta

[@junaidali606]

Are there any medical conditions that can exacerbate thoracic outlet syndrome?

[@DrSimonFreilich]

Great question! In short Yes. Lets break these apart a little bit as it's a bit nebulous. For the most common - Symptomatic TOS: Any medical condition affecting the joints / ligaments / muscles can exacerbate it. For the Vascular TOS (particularly arterial) - any pre-existing medical condition affecting circulation or flow (from a symptoms perspective, this can include any of the underlying causes of Raynaud's). For the True Neurogenic TOS - not as much, as most people are younger and relatively healthy. Conceivably, a pre-exisiting neuropathy could exacerbate it. Bw Simon

[@junaidali606]

@@DrSimonFreilich thanks for a very informative reply

[@karlacervinkova2265]

Hello. I have problems one year And Still doctors dont know what Is it. I have very much pain on the left of my neck And extreme big left jugular vein when i am speaking or when i give my left hand up And my left side od my neck Is Very paintful when i am speaking. I have pain on left side od neck, left hand And tingle my second finger. Can be this TOS syndrom please?

[@StarShootex]

Can this cause vertebral artery compression leading to dizziness?

[@DrSimonFreilich]

Possible but would be very rare. Bw Simon

[@lw7654]

@@DrSimonFreilich if the scalenes are being squeezed, they lie under the scm muscle which can cause dizziness. Since they are in close proximity of each other wouldn’t it be probable it would cause dizzness? Also, would the trapezius and scapular also be affected from tos to a point the trap is constantly being contracted and the scapular feels like it is being locked down? Thank you

[@jayaywak]

can vasoconstrictors/dilators like magic mushrooms/alcohol exacerbate numbness and tingling symptoms?

[@DB1956]

If whilst on alcohol and mushrooms you neglect to notice you have been lying on your arm badly for a couple hours - undoubtedly.

[@arnaudlequilliec1173]

I have a question in term of nerve. I underwent TOS surgical decompression two month ago. Emg and evoked potential were cleared. Nevertheless, why my hand keeps going numb and I have fine motor skill problem and I feel the nerve path in my arm if there is no damage ?

[@DrSimonFreilich]

Bonjour Arnaud. You'll need to speak with your surgeon about what they think is going on. Sometimes these can take a while to settle, sometimes there can be scar tissue. Lots of variables so hard to give you a definitive answer. Bw Simon

[@arnaudlequilliec1173]

Dr Simon Freilich already at 2 months ? Thanks for the answer by the way :)

[@DrSimonFreilich]

It's big and complex surgery, so there's lots of considerations. Bw Simon

[@skyiscute24letsmakeherfamo44]

Please help me I’ve had t.o.s surgery and I’m miserable im pretty sure I am going to cut my arm off I can’t take this pain anymore

[@silverfullbuster9177]

How are you know

[@jackmockler8347]

hi, im wondering if you can have TOS with only present pain at base of neck, no radiating pain, arm weakness or numbness

[@RossiGucci]

Boa Tarde senhor Doutor, gostaria de saber se acha que o síndrome do canal do carpo está relacionado com o síndrome do desfiladeiro torácico?

[@DrSimonFreilich]

Obrigado! Não, eles não têm nada a ver um com o outro. no entanto, o túnel do carpo pode ser confundido com ele. Espero que o Google tradutor tenha funcionado. muitas felicidades, Simon

[@RossiGucci]

Não percebi.... Desculpe

[@RossiGucci]

@@DrSimonFreilich obrigado pela resposta doutor. Eu tenho os ombros redondos e dizem que posso ter artéria comprimida.... Acredita na fisioterapia para o túnel do carpo? Eu tenho muito discreto

[@DrSimonFreilich]

Sinto muito, mas não posso fornecer diagnóstico on-line. cumprimentos Simon

[@RossiGucci]

What is the diagnostic method to know if I have the thoraxic syndrome

[@DrSimonFreilich]

Hi Pedro, this isn't a condition for self diagnosis. You'll have to see a local doctor. Bw Simon

[@jessmontgomery4356]

Hello. I was diagnosed with TOS in 2003 having my first rib removed om my left side. Unfortunately it didnt help me. I have since been in pain and having alot of problems with my muscles joints nerves bones etc. It has gotten so bad i cant hardly get up in the mornings. I have mucles wasting. Can you please tell me what i should do and who i should see to get me the proper diagnosis and care.? Im lost at this point. Thank you

[@DrSimonFreilich]

Hi Jess - always speak to the doctor who operated in the first instance. They know your anatomy and will have notes on exactly what was done. They can then guide you further. Bw Simon

[@PTBDRSh]

U are brilliant sire

[@annap1191]

Can it cause issues in oxygen supply to heart ?

[@DrSimonFreilich]

Hi, as far as I'm aware it shouldn't, as its blood supply occurs almost immediately in the aortic plumbing. Bw Simon

[@annap1191]

@@DrSimonFreilich Can a c56 fusion lead to TOC because it has altered the shape of the cervical spine curve?

[@parvathymalu4032]

Thank you sir

[@airplanemode6757]

Can dis syndrome also cause pain in the rib under my breast like i get pain when i breath especially

[@DrSimonFreilich]

No, not this one. bw Simon

[@FAMOUSLEXX10]

I was diagnosed with TOS a few months back. I presented with what I believed were heart issues since most of my discomfort originated on my left pec and mid back all on the left side. My question is, is it pretty common to feel discomfort in your chest and mid back with TOS. It really mimics heart attack symptoms and has caused me quite a bit of anxiety. Thank you Dr.

[@rm6442]

I have recently been diagnosed with TOS too and have both the neurogenic and arterial kind. My pain is also mostly in my left pec, chest and mid upper back area. I have the usual symptoms in my neck, shoulder, arm, and hand, but that's where most of my pain is located. I have battled for years to be taken seriously by my doctors and other specialists and I ended up diagnosing myself before they would test for TOS. I also have neurogenic pec minor syndrome, so definitely look into that. It is called the 'cardiac copycat' and can present with heart attack like symptoms. I have been rushed to hospital 5 times over the years because the pain was so bad. I am now awaiting surgery, but I am still receiving conflicting I information from the various specialists I have seen recently. It really is so hard to know what to do for the best. Just know you are not alone. It's an awful condition, it really is.

[@BlueSky-qe4jn]

@@rm6442 I've been 2 times at ER, because of left sided chest pain, arm tingling, numbness. Even my left feet is twitching for 1 month. I did a lot of tests, all negative. And now I am too battling to be taken seriously. I belonging to risk category: I have scoliosis, neck arthrosis, PEX, trigger points, and doing repetitive job for more than a year. Nobody let me to explain my symptoms properly and try to minimize them. Kind of maybe you're stressed etc...It makes me frustrated.

[@rm6442]

@@BlueSky-qe4jn I really feel for you. The worst thing is feeling like you aren't being heard - or taken seriously. I was lucky to find a great specialist in Bristol in the UK and he assessed me properly and has been an enormous help in me getting treatment. I had to pay privately, but it was worth every penny. I really hope you get the right help soon. It's beyond frustrating, I know. And I too was fobbed off with "maybe it's anxiety" by some doctors.

[@flowerpixel]

Thanks for this video! Tos is overwhelming to read about. I was recently dxd with carpal tunnel from a nerve study with decreased motor action potentials in my apb. But to complicate things I have hypermobile Ehlers Danlos syndrome and a lot of us are diagnosed with symptomatic tos bc our shoulders are so floppy. I've never dislocated but I've stretched my bp several times (a decade ago). I'm hoping the ncv is correct and this is actually just carpal tunnel I'm assuming if my ulnar nerve study was normal then it is *not* tos but likely CTS? Unless its some radiculopathy

[@arnaudlequilliec1173]

Hi Doctor, Is the extra rib/apophysomegaly mandatory for true neurogenic TOS or it can also occure between the collarbone and 1st rib ? Furthermore, in studies or litterature, does the operation release really from pain ? One last question, is the venous (arterial or venous) TOS painful ? Thank you in advance, Arnaud LE QUILLIEC French medecine student

[@DrSimonFreilich]

Hi Arnaud, lots of questions! There are many anatomical variations that are associated with TOS. I once had a paper that went through all of them, but I've struggled to find it again so I'm going to say that anything is possible as it's a very complex and crowded space. Surgery, as far as I understand, does relieve pain and the vascular forms certainly can be painful. Bw Simon

[@arnaudlequilliec1173]

@@DrSimonFreilich Thank you very much for your prompt answer. I was meaning surgery by writing operation :) Translating french to english from my mind.. Good evening

[@amih2127]

Dear Dr. I am diagnosed with TOS right arm, but not changing color or numbness just pain in neck and shoulder wich get worse through acticity such as walking or... Whole videos on youtube are scary and most of the patients after many years of suffering deal with the surgery. Is PT really helpful? Thank you in advance

[@arnaudlequilliec1173]

I have been diagnosed as well. Try to put these videos or opinion away cause people who will speak about it are obviously unsatisfied.

[@DrSimonFreilich]

Hi Ami, I can't really answer for your particular circumstance but physiotherapy is helpful for some (and the benefit varies between the different types). Bw Simon

[@yashmahapatra3011]

Can this be cured with phyiso therapy? Please answer

[@DrSimonFreilich]

Hi Yash, depends on which type as you'll see if you watch the video. Bw Simon

[@slingbladejeff]

DOCTORS SUCK TODAY.IVE BEEN IN PAIN FOR 35 YEARS. THEY DONT TAKE THETE TIME.ITS ABOUT MONEY. THATS IT.

[@gracymathew]

Thanks for the great information video on TOS. Can we have disequillibrium/dizziness with arm activities now if someone was diagnosed with thoracic outlet syndrome in 1986 and not treated?

[@DrSimonFreilich]

Hi, I doubt it. Bw Simon

[@krystofphilipbobenrieth1029]

Hi, it could be Trigger points related to TOS, for example, Sternocleidomastoid trigger points. Hope you've already addressed it or you are able to assess it now.

[@semajsga]

Comment for engagement

[@rocknroll506]

Anyone else have bilateral cervical ribs?