Musculoskeletal Condition · Glastonbury, CT

Thoracic Outlet Syndrome

Nerve or vessel compression near the collarbone causing neck, shoulder and arm symptoms: evaluation and non-surgical options with Dr. Paul Tortland, DO.

Written and clinically reviewed by

Paul D. Tortland, DO, FAOASM, CAQSM, RMSK

Dr. Paul Tortland, DO is a non-surgical orthopedic & sports medicine physician specializing in regenerative orthopedics and surgical alternative treatment. He is dual board-certified in Sports Medicine & Osteopathic Manipulative Medicine (OMM) and Regenerative Medicine, Fellowship-trained in Sports Medicine. He became the first physician in the world to earn board certification in Regenerative Medicine in 2015. Diplomate, American Board of Regenerative Medicine (ABRM), 2015. Registered in Musculoskeletal Ultrasound (RMSK).

Condition

What is thoracic outlet syndrome?

Compression of the nerves or blood vessels in the narrow space between the collarbone and first rib, which can cause pain in the neck and shoulder, numbness or tingling in the arm and hand, and arm fatigue with overhead use. Evaluation distinguishes nerve from vascular causes; treatment often starts with targeted rehabilitation and posture work, with ultrasound-guided injection options considered in selected cases. Sudden arm swelling, color change, or severe pain needs urgent care.

Explore related conditions: Browse the Back and spine condition hub for related diagnoses and treatment options.

CARE OPTIONS

How is thoracic outlet syndrome treated?

Dr. Tortland’s potential treatment options: Dr. Tortland may evaluate whether symptoms reflect a musculoskeletal or nerve-compression problem and whether any targeted intervention is appropriate. Orthobiologic injections are not a standard treatment for every form of thoracic outlet syndrome; careful diagnosis and vascular or nerve-specialist input may be needed before considering a procedure.

Physical therapy and traditional care: Treatment often begins with physical therapy focused on posture, shoulder-girdle mechanics, and gradual movement, along with ergonomic changes and avoiding positions that reproduce symptoms. The plan differs for neurogenic, venous, and arterial forms.

When other care may be needed: A suddenly swollen, blue, cold, or painful arm, or new hand weakness or circulation changes, requires urgent assessment. Vascular symptoms should not be managed as routine muscle tightness.

Common questions

Questions about thoracic outlet syndrome

What causes thoracic outlet syndrome?

Thoracic outlet syndrome occurs when nerves or blood vessels are compressed between the collarbone and first rib or by tight neck and chest muscles. Posture, trauma, repetitive overhead activity, and extra ribs can contribute.

What are the symptoms of thoracic outlet syndrome?

Symptoms can include neck, shoulder, or arm pain, numbness or tingling in the hand, and a heavy or tired arm. Arm swelling, a color change, or a cold hand needs prompt medical evaluation.

What are the non-surgical treatment options for thoracic outlet syndrome?

Treatment often begins with posture and movement retraining, targeted physical therapy, and activity changes. Image-guided injections may help in selected cases. Surgical referral is considered for vascular involvement or persistent symptoms.

What regenerative options may help thoracic outlet syndrome?

Hydrodissection may be considered only for selected, confirmed peripheral nerve entrapment; it is not a general treatment for thoracic outlet syndrome. Prolotherapy is not established as routine care. The type of thoracic outlet involvement must be clarified before any injection is discussed.