Neck & Shoulder

What It Is

Line drawing of the side of the neck and shoulder, showing the nerve bundle leaving the neck between the scalene muscles and passing down beneath the collarbone and over the first rib toward the arm. — The nerves to your arm squeeze between the scalenes and then under the collarbone — two of the spots I check first.

Thoracic outlet syndrome (TOS) is a group of conditions where nerves or blood vessels are squashed or irritated in the thoracic outlet, the narrow space between the collarbone and the first rib (AAOS, n.d.; NHS, 2023). This can cause pain in the neck, shoulder and arm, as well as pins and needles or numbness in the hand and fingers. One of the most common places for the nerves to be squeezed is between the scalene muscles at the side of the neck (Camporese et al., 2022).

Common causes include an injury to the chest, neck or ribs, such as a car accident, being born with an extra rib in the neck (a cervical rib) or another difference in the shape of the first rib, and jobs or activities that involve lots of repetitive arm movements, such as building work or a lot of swimming (NHS, 2023; AAOS, n.d.). There are instances where doctors aren't able to find a cause. Treatment usually includes physiotherapy and medicines to ease pain, and most people improve with these (NHS, 2023; Cleveland Clinic, 2026), but injections and surgery are also options in some cases.

TOS can compress both nerves and blood vessels. So the symptoms in the arm vary between a dull ache, throbbing, sharp pain and a dead arm feeling.

What Causes Thoracic Outlet Syndrome?

Different experts put the causes down to different underlying problems. As well as the causes above, poor posture, with the shoulders rounded forwards and the head in a forward position, can lead to or aggravate the condition, as can being overweight, having large breasts, or gaining a lot of muscle, for example through body building (NHS, 2023; AAOS, n.d.). Improving your posture is an important part of treatment, because postural exercises help you sit and stand straighter, which lessens the pressure on the nerves and blood vessels (AAOS, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Signs & Symptoms

Which symptoms you have depends on what is being squeezed. Pressure on the nerves is much more common than pressure on the blood vessels (AAOS, n.d.).

Pressure on the nerves can cause a vague, aching pain in the neck, shoulder, arm or hand; pain, numbness or tingling on the inside of the forearm and in the ring and little fingers; and weakness that can make the hand clumsy (AAOS, n.d.)
Pins and needles may be worse at night and wake you up (NHS, 2023)
Pressure on the blood vessels can cause swelling, redness or other colour changes in the arm, or make the arm and hand feel cold and tire easily (AAOS, n.d.; NHS, 2023)
Overhead activities are often particularly difficult (AAOS, n.d.)

Treatment

Self-Care & Treatment

How to Treat Thoracic Outlet Syndrome

If you have the nerve type of thoracic outlet syndrome, physical therapy is usually the first treatment (Cleveland Clinic, 2026; Camporese et al., 2022), with shoulder strengthening and postural exercises (AAOS, n.d.) that, over time, help to reduce pressure on the nerves and blood vessels (NHS, 2023). I can guide you through these exercises and ease tight neck, chest and shoulder muscles with hands-on work. See the My Approach tab for how I work.

1. Medication

AAOS OrthoInfo (n.d.) says that anti-inflammatory medicines (NSAIDs), such as naproxen and ibuprofen, can ease the pain and reduce swelling. (This medicine information comes from AAOS OrthoInfo, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Prescription medicines: a doctor may prescribe medicines to help with pain, relax muscles, improve circulation or reduce the risk of blood clots (NHS, 2023).
Clot-dissolving treatment: if a blood clot forms in a vein or an artery (venous or arterial TOS), medicine given in hospital through a drip or a thin tube (catheter) can dissolve it, and blood-thinning medicine may also be prescribed (Cleveland Clinic, 2026).
Injections: a doctor may inject botulinum toxin into the muscles (Cleveland Clinic, 2026).
Tests: a doctor may arrange an X-ray, CT, MRI or ultrasound scan, or nerve and circulation tests (AAOS, n.d.; NHS, 2023).
Surgery: this may be offered if other treatments have not helped, or for serious problems such as blood clots. It may involve removing part of an abnormal first rib or an extra rib, or releasing a muscle that joins the neck and chest (AAOS, n.d.; NHS, 2023). Most people with the blood-vessel types of TOS need surgery (Cleveland Clinic, 2026).

How I can help (see the My Approach tab)

Hands-on work for tight neck, chest and shoulder muscles

Shoulder blade strengthening and posture exercises

Breathing retraining

Advice on lifting, bags and your workstation

Tips

If you are prone to thoracic outlet compression, change the everyday activities that aggravate your symptoms, such as heavy lifting or lifting objects above your head; changing your workstation layout may also help (AAOS, n.d.; Cleveland Clinic, 2026).
If you are overweight, losing weight can help, as extra weight stresses the shoulder muscles that support your collarbone (AAOS, n.d.).
Avoid carrying heavy bags on your shoulder, as this pushes the collarbone down and increases the pressure in the thoracic outlet (AAOS, n.d.).
Do simple exercises daily to keep your shoulder muscles strong; I can show you suitable ones. Stop any exercise that causes pain (AAOS, n.d.).
Have your symptoms checked and treated at an early stage rather than waiting for them to go away (Cleveland Clinic, 2026).

Treatment

My Approach

Line drawing of the chest muscles in four views, including the small pectoralis minor running from the upper ribs to the front of the shoulder blade beneath the larger pectoralis major. — Pec minor sits right over the path the nerves take into the arm, so a tight one is worth looking at.

Thoracic outlet syndrome is a squeeze on the nerves or blood vessels heading to your arm as they pass between the neck muscles, collarbone, first rib and the small chest muscle under the front of the shoulder. Most often it's the nerves. My aim is to give them more room by easing tight muscles, freeing up the collarbone and upper ribs, and building the posture and strength to keep the space open.

I start by assessing your posture, breathing and neck and shoulder movement, and screening the nerves (sensation, reflexes and strength) and circulation in your arm. That tells us which path you're on.

If It's Mild

Aching, pins and needles or numbness that comes and goes, without weakness or colour changes in the hand, is something I can treat directly.

Myofascial and trigger point work and gentle stretching for the side of the neck, chest, upper back and shoulder blade muscles
Light pressure right under the collarbone, where the nerves run
Gentle mobilisation for the collarbone and upper ribs, and gentle nerve glides within comfort
Breathing low into your belly, so your neck muscles aren't working all day
Shoulder blade strengthening, posture exercises and a home programme: a warm shower, then gentle neck and chest stretches
Breaking up overhead work, heavy shoulder bags, phone-cradling and long desk spells

If It's More Severe

Weakness or clumsiness in the hand, numbness that's getting worse, or swelling, colour changes or coldness in the arm need to be checked by your family doctor or nurse practitioner first. Then I can support their plan with gentle hands-on work, breathing and posture work. After surgery, I need your surgeon's okay before any hands-on treatment.

Chest wall work is only with your informed consent and a written consent form. Signs of a blood clot mean getting urgent help (see When to Get Urgent Help).

What to Expect

Typical Course

Typical course: For milder nerve symptoms, most people come once or twice a week at first, then weekly, then less often as you manage more on your own, with a reassessment at about 4 to 6 weeks; expect some improvement by about three months, and keep the exercises going after you feel better. For more severe cases, visits and the timeline follow your medical team's plan.

What I Focus On

Nerve & Circulation Screening

Neck & Chest Release

Shoulder Girdle Mobility

Breathing

Postural Strength

Please read

When to See a Doctor First

When to Get Urgent Help

Throbbing or cramping pain, swelling, redness and warmth in one arm could be signs of a blood clot caused by TOS. Blood clots can be life-threatening if not treated quickly, so get urgent medical attention or call 911 for an ambulance the same day (NHS, 2023).
Call 911 or go to the emergency room at your nearest hospital if you have sudden breathlessness, sharp chest pain (which may be worse when you breathe in) and a cough or coughing up blood (NHS, 2023).

Sources

References

NHS (2023) Thoracic outlet syndrome. Available at: https://www.nhs.uk/conditions/thoracic-outlet-syndrome/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Thoracic outlet syndrome. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/thoracic-outlet-syndrome/ (Accessed: 7 October 2026).
Cleveland Clinic (2026) Thoracic outlet syndrome. Available at: https://my.clevelandclinic.org/health/diseases/17553-thoracic-outlet-syndrome-tos (Accessed: 7 October 2026).
Camporese, G. et al. (2022) 'Diagnostic and therapeutic management of the thoracic outlet syndrome. Review of the literature and report of an Italian experience', Frontiers in Cardiovascular Medicine, 9, 802183. doi: 10.3389/fcvm.2022.802183

Massage therapy · Kitchener–WaterlooThoracic Outlet Syndrome

What It Is

What Causes Thoracic Outlet Syndrome?

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Treat Thoracic Outlet Syndrome

1. Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's Mild

If It's More Severe

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooThoracic Outlet Syndrome

What It Is

What Causes Thoracic Outlet Syndrome?

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Treat Thoracic Outlet Syndrome

1. Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's Mild

If It's More Severe

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Carpal Tunnel Syndrome

Wry Neck

Hyperkyphosis

Anterior Scalene Syndrome

Book a session