Pain, numbness, tingling, or weakness in the shoulder, arm, or hand that is worse with overhead activity and has not resolved with neck or shoulder treatment may be coming from the thoracic outlet — the narrow space between the collarbone and the first rib where nerves and blood vessels can become compressed. This is thoracic outlet syndrome. It is frequently misdiagnosed. It is a real, treatable condition. Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), is one of very few surgeons in the UK offering robotic keyhole decompression for thoracic outlet syndrome. Surgery is considered only after conservative treatment has been tried. All patients treated to date have experienced significant improvement in their symptoms. Private appointments within 2–3 days. No GP referral required.
Last reviewed: April 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Thoracic outlet syndrome is commonly mistaken for cervical spine disease, rotator cuff injury, or carpal tunnel syndrome. Many patients have had treatment for these conditions without improvement before TOS is considered. If that applies to you, this is worth assessing.
Surgery is not the first step. Physiotherapy, posture work, and activity modification are always tried first. Surgery is considered only where conservative treatment has not achieved adequate improvement and the anatomy of compression is clearly surgical.
Dr Okiror is one of very few surgeons in the UK offering thoracic outlet decompression via a robotic keyhole approach. All patients treated to date have experienced significant improvement. Less disruption and faster recovery than open surgery.
The thoracic outlet is the narrow space between the collarbone and the first rib, through which the nerves and blood vessels that supply the arm pass from the neck. When this space is too tight, those structures become compressed — causing the symptoms in the arm and hand.
The most common form. Nerves compressed, causing pain, numbness, tingling, and weakness in the arm and hand. Worse with overhead activity or carrying. The hand may feel clumsy or weak.
Most common form
Vein compressed, causing arm swelling, heaviness, and sometimes blue discolouration. Can cause blood clots in the arm vein. Often occurs after vigorous overhead activity. Needs prompt assessment.
Seek prompt assessment
Artery compressed, causing coldness, pallor, and pain in the arm and hand. Least common but most serious form. Can affect blood supply to the hand. Requires urgent specialist assessment.
Seek urgent assessment
The symptoms of thoracic outlet syndrome overlap with cervical spine disease, a rotator cuff injury, or carpal tunnel syndrome. These are more common conditions, so they are investigated and treated first.
The difference is that TOS symptoms are typically worse with overhead activity, involve the whole arm and hand rather than a single nerve area, and do not improve with cervical spine or shoulder treatment. If your neck has been treated, your shoulder investigated, and carpal tunnel injected — and you still have the same symptoms — thoracic outlet syndrome is the diagnosis worth considering.
All patients treated by Dr Okiror for thoracic outlet syndrome to date have experienced significant improvement in their symptoms following surgery.
Questions most commonly asked by patients with persistent arm and hand symptoms not resolved by neck or shoulder treatment.
Book an Assessment →Or call Jo Mitchelson:
020 7952 2882
No GP referral required. Private appointments at London Bridge Hospital within 2–3 days. Dr Okiror will assess whether thoracic outlet syndrome is the cause — and give you a clear answer and a clear plan.
Jo Mitchelson, Private PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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