Doctors warn of rise in thoracic outlet syndrome linked to desk-based work

Health experts are raising the alarm about an apparent increase in cases of thoracic outlet syndrome, a condition in which nerves or blood vessels that run from the neck to the shoulder become compressed, leaving some patients unable to raise their arms. Surgeons say they are increasingly seeing younger adults — including people in their mid- to late 20s — presenting with symptoms that were previously more common among older patients or those with a history of trauma or heavy repetitive arm use.

Clinicians point to prolonged forward head posture and rounded shoulders from extended periods working at laptops and mobile devices as a likely contributor to the trend. "Being on laptops and mobile phones all the time gives us a chronic forward head posture which together with rounded shoulders reduces the already narrow space where the nerves going to the arms feed through," said Dr. Sabine Donnai, a GP and founder of a private London clinic.

Thoracic outlet syndrome occurs when the subclavian artery or vein, or the brachial plexus bundle of nerves, is compressed as it passes through the small gap between the collarbone and the first rib. Symptoms can be vague and diverse and often include numbness or tingling in the arm or fingers, neck or shoulder pain, arm fatigue, a weak grip and swelling. In some cases patients report severe pain that limits movement.

The condition has long been associated with repetitive arm actions such as gardening or tennis, or with blunt trauma such as a car accident. In older patients, excessive muscle use can cause swelling and inflammation that slightly reduces the thoracic outlet’s size. Clinicians now say sedentary desk work and device use may similarly alter posture and contribute to compression in younger people.

Research on the condition is limited and prevalence estimates vary. Some studies put the average prevalence at about three people per 100,000, while other experts suggest it could be as common as three per 1,000. Recent investigations in the United Kingdom indicate that women comprise a majority of diagnoses. A 2024 analysis published in The Annals of The Royal College of Surgeons of England found 64 percent of patients were female and included people as young as 27. A separate British study published earlier this year in the Annals of Vascular Surgery reported that two-thirds of patients with thoracic outlet syndrome were female.

Doctors say anatomical differences may make women more susceptible. The thoracic outlet tends to be anatomically smaller in women, and higher oestrogen levels can influence collagen production and joint laxity, factors clinicians say could increase vulnerability to compression.

Diagnosing thoracic outlet syndrome can be challenging because its symptoms overlap with other shoulder and neck conditions, and there is no universally accepted diagnostic criterion in the United Kingdom. A 17-year review published last year in The Annals of The Royal College of Surgeons of England reported that patients waited an average of 18 months for a diagnosis. The Medway NHS Foundation Trust team that contributed to that review noted referrals into hospitals came from a variety of specialties, including neurology, orthopaedics and pain management, and concluded that the UK would benefit from clearer referral pathways. They contrasted that with the United States, where some hospitals have established referral criteria.

Treatment options aim to relieve compression and manage symptoms, but there is no single cure. Under National Health Service guidance, initial management often involves physiotherapy with stretching and strengthening exercises designed to reduce pressure on nerves and blood vessels. Medications may be prescribed to treat pain, relax muscles, improve circulation or reduce the risk of blood clots. Surgery is typically reserved for severe cases, such as those involving blood clots, or when conservative measures fail.

Public-health and workplace guidance stresses posture and ergonomics. The NHS advises patients to "don't slouch" and recommends positioning screens at arm’s length and eye level. Employers commonly promote ergonomic measures such as adjustable chairs, desk positioning and standing desks to reduce prolonged poor posture. Experts caution, however, that there is no universally accepted definition of perfect posture and that simple advice may not prevent all cases.

Clinicians and vascular surgeons have called for more research and nationally consistent referral pathways to reduce diagnostic delays and variation in care. With device use ubiquitous in modern workplaces, physicians say awareness among primary care providers, occupational health services and patients themselves could lead to earlier intervention and better outcomes.

Until more definitive data are available, doctors recommend that people who experience persistent neck, shoulder or arm symptoms seek medical assessment. Early physiotherapy and attention to ergonomic setup at work may reduce symptoms for many patients, while severe or progressive signs — such as pronounced weakness, swelling or circulatory changes — should prompt urgent specialist review.