Pain, Fatigue & Numbness in Arm & Shoulder

Numbness and a general Feeling of fatigue into the arm and shoulder are common symptoms of a condition known as Thoracic Outlet Syndrome. The Thoracic Outlet Syndrome (TOS) which is situated behind the collarbone in an area where nerves and the subclavian vein and artery pass through. The condition occurs when either the nerves or the subclavian artery and veins that provide sensation and muscle control and blood supply to the arm becomes compressed. This compression can be caused by one of the following factors; (a) tight scalene neck muscles, (b) an elevated 1st rib, (c) tight Pectoralis Minor chest muscles, (d) an additional upper rib (known as a cervical rib).

So how can we tell what is causing the Pain?

  • Well rounding forward of the shoulders and winging of the shoulder blades indicates a tight pec minor chest muscle with the nerve compression beneath this tight muscle.

  • Inability or restricting on side bending the neck may indicate scalene muscle tightness in the neck region pressing on the nerve or artery.

  • If the 1st rib or an abnormal cervical rib is involved then this needs to be diagnosed in clinic by the Practitioner.

  • Common faults that cause Thoracic Outlet Syndrome include Forward Head Posture, previous fracture to the collar bone or shoulder blade.

Symptoms include:

  • Feeling of fatigue into the arm which is aggravated by carrying bags or doing overhead work.

  • Pain & Numbness along the inside region of the arm and upper shoulder region

  • Symptoms are often worse at night

  • General feeling of fatigue into the arm & shoulder

  • There may be Swelling & Discoloration into the forearm due to compression of the subclavian vein

  • Sleep Disturbance & Muscle wastage in severe cases

Management & Treatment

If the problem is caused by tight scalene muscles of the neck then what is very helpful is manual release of these muscles and postural control exercises. Likewise if the pec minor muscle of the chest region is causing impingement then I find then manual release coupled with taping of the shoulder blade into its correct neutral position helps reduce impingement. If an elevated 1st rib is diagnosed as the source of impingement then simply mobilizing the 1st rib downwards can help. Education on breathing techniques in order to avoid biased upper chest breathing patterns is important here also. Finally, mobilizing the thoracic spine can help also by aiding correct shoulder blade movement.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Clonmel & Thurles. Contact Number: 0504 26672

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Physiotherapy & Injury Rehabilitation Clinic in Tipperary

0504 26672


The Surgery, Fianna Road, Thurles


Riverside Medical Centre, 7 Upper

Irishtown, Clonmel

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