Mid-Back & Ribs
Thoracic Outlet Syndrome
Also called: TOS
Compression of nerves (most commonly) or blood vessels as they travel from the neck through the space behind the collarbone into the arm. Produces arm symptoms that worsen with overhead positions and carrying. Often driven by posture, tight scalene/pec minor muscles, or an extra cervical rib.
Common signs
- Aching, tingling, or numbness down the arm, often the inner forearm and ring/little fingers
- Symptoms with overhead work, carrying bags, or arms-up sleeping
- Arm fatigue or heaviness with use
- Occasionally hand color/temperature changes (vascular type)
Seek help now if
- Sudden arm swelling, discoloration, or cold pale hand — vascular emergency
- Progressive hand weakness or muscle wasting
- Symptoms after trauma to the neck/shoulder
If any of these is sudden or severe, call 911 or go to an emergency room. For the others, get examined before you start self-care.
What to do first
- A structured exam differentiates TOS from cervical radiculopathy, cubital tunnel, and carpal tunnel — these are commonly confused
- Reduce provocation: lighten shoulder bags, break up overhead work, avoid sleeping with arms overhead
- Begin first-line care: posture, nerve glides, and releasing the scalene/pec minor region
The longer road
- Most neurogenic TOS improves with 8–12+ weeks of dedicated conservative care — consistency matters more than intensity
- Stubborn cases warrant imaging for structural causes (cervical rib, band) and specialist consult
- Vascular types are managed with vascular specialists from the start
Natural healing options we use
- Chiropractic care for the cervical spine, first rib, and clavicle mechanics
- Manual therapy for scalenes and pectoralis minor
- Neural mobilization for the brachial plexus
- Postural strengthening (lower trapezius, serratus)
- Breathing retraining to reduce accessory-muscle overuse
About imaging
X-ray can reveal a cervical rib. Further vascular studies or MRI when the type or cause is unclear or symptoms are not responding.
Daily self-care
- Nerve glides daily as instructed — gentle, never into worsening tingling
- Backpack instead of one-shoulder bags
- Frequent posture resets; open the chest, lengthen the neck
How we can help
More in Mid-Back & Ribs
Thoracic Sprain/StrainRib Joint DysfunctionCostochondritisScheuermann's KyphosisIntercostal NeuralgiaUpper Crossed / Postural SyndromePostural Hyperkyphosis
Please read: this page is education, not a diagnosis. A proper examination is how a condition gets confirmed and a plan gets built. See our medical disclaimer.