‘When your persistent hand pain and heaviness is coming from higher up the arm’
Neurogenic thoracic outlet syndrome (NTOS) occurs when the brachial plexus — the bundle of nerves that supply your entire arm, running from the neck into the arm — becomes compressed or irritated as it passes through a narrow space between the collarbone and first rib, known as the thoracic outlet
Although symptoms are commonly felt in the hand, the source of these symptoms can be much higher – in the thoracic outlet, at the base of the neck. Approximately 95% of thoracic outlet compression cases are related to the nerves, hence the name neurogenic thoracic outlet syndrome. However, rarer cases can include compression of the blood vessels in this space, known as the subclavian artery and vein. In some instances, you can have a combination of both.
Common Symptoms
Symptoms vary between individuals with NTOS but can commonly include:
Symptoms are often aggravated by:
Some people are born with anatomical variants that may predispose them to NTOS. These can include:
Why Is It Often Missed?
NTOS is commonly misdiagnosed because symptoms overlap with many other, more prevalent conditions. On average, people wait 5 to 7 years before a correct diagnosis of NTOS is made.
People are frequently treated for:
There is no singular scan or test to confirm NTOS. Even nerve conduction studies may appear normal. However, a combination of a correct therapy assessment, relevant imaging modalities/tests, and exclusion of other conditions can aid a correct and prompt diagnosis of NTOS.
How Can Therapy Help?
Specialist therapy is not only pivotal in assessing and ensuring the correct work-up for your symptoms, but it is also the mainstay treatment in conservative management for NTOS by aiming to reduce the mechanical stress on your nerves.
Therapy may include:
Key Message
If you are experiencing persistent pain, tingling, heaviness, or weakness in your hand and arm, especially when symptoms worsen with sustained postures and overhead positions, and if multiple previous interventions have not changed your symptoms, the problem may be originating from the thoracic outlet. Early recognition and targeted rehabilitation can make a meaningful difference to your symptoms and quality of life long-term.
Christian Rushton has a special interest in neurogenic thoracic outlet syndrome and its assessment, diagnosis and conservative management.
Yonali and Monica recently travelled to Brisbane to attend the three-day Healthia Recent Graduate Conference, an immersive learning experience designed to further develop clinical skills and knowledge. The conference featured intensive practical workshops focused on the assessment, management, and treatment of a wide range of upper limb conditions, while also providing valuable opportunities to refine advanced splinting techniques through hands-on training.
Attending the conference was an excellent opportunity to learn from experienced clinicians, collaborate with fellow recent graduates, and build confidence in evidence-based hand therapy practice. Our therapists are excited to apply the knowledge and practical skills gained throughout the conference to continue providing the highest standard of care for our patients.
A big thank you to the Healthia team for organising such an informative, engaging, and beneficial conference. We are grateful for the opportunity to continue learning and growing as clinicians.
Congratulations to our Senior Admin Member of the Month, Melanie!
Melanie has recently celebrated an incredible five years with our team, and we’re so grateful for everything she brings to MHT. She is conscientious, reliable and incredibly meticulous in everything she does. Whether she’s managing remittances, taking on additional responsibilities or supporting the team behind the scenes, Melanie consistently goes above and beyond. Her kindness, friendly nature and willingness to help make her a valued colleague and a true team player. Thank you, Melanie, for your dedication, hard work and the positive impact you have every day—we’re lucky to have you!
Have you experienced exceptional care or teamwork from someone at MHT? We’d love to hear about it.
Help us celebrate those who go above and beyond.
