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Thoracic Outlet Syndrome in Rock Climbers: What You Need to Know

Updated: Jul 9

Have you ever experienced a fullness feeling or numbness/tingling in the arm or hand while climbing on a particularly pumpy and reachy route? While there are multiple reasons for these symptoms in climbers, one lesser-known but potentially serious condition that climbers should be aware of is Thoracic Outlet Syndrome (TOS).


What Is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome occurs when nerves, arteries, or veins are compressed as they pass through the thoracic outlet—a narrow space between the collarbone and the first rib. This area is a key passageway for the brachial plexus (a network of nerves that controls the arm) and major blood vessels. The brachial plexus takes a complex path through the scalenes, between the clavicle and first rib, then under the pec minor. It is important to work with a physical therapist experienced in treating these symptoms to find exactly where the compression is happening.

There are three main types of TOS:

  1. Neurogenic TOS – Compression of the brachial plexus nerves (most common).

  2. Venous TOS – Compression of the subclavian vein.

  3. Arterial TOS – Compression of the subclavian artery (least common but most serious).

    Graphic of the brachial plexus and subclavian vein/artery pathway
    Graphic of the brachial plexus and subclavian vein/artery pathway

Why Rock Climbers Are at Risk

Climbers frequently engage in overhead arm movements and maintain intense, static postures that strain the shoulders, neck, and chest. These repetitive movements can cause:

  • Muscle hypertrophy in the scalene or pectoralis minor muscles.

  • Forward head posture and rounded shoulders from poor posture or training imbalance.

  • Scar tissue or inflammation from microtrauma.

All of these factors can narrow the thoracic outlet and compress vital structures.


Common Risk Factors in Climbers:

  • Overdeveloped chest or shoulder muscles without balancing antagonist training.

  • Poor scapular mobility and stability.

  • Repetitive high-reaching or lock-off movements. (most common)

  • Carrying heavy packs on narrow shoulder straps.

  • Previous clavicle or rib injuries.

  • Anatomical abnormality called a "cervical rib", which is an extra rib above the first rib that can compress the nerve and vascular structures.


Signs and Symptoms

Symptoms can vary based on which structure is compressed. Look out for:

Neurogenic TOS:

  • Numbness or tingling in the arm, hand, or fingers.

  • Weak grip or arm fatigue.

  • Pain or ache in the neck, shoulder, or hand.

Venous TOS:

  • Swelling in the arm or hand.

  • Bluish/purpleish discoloration.

  • Heaviness, fullness, or tightness, especially during/after climbing.

Arterial TOS:

  • Cold hands or fingers.

  • Pale or bluish skin.

  • Weak or absent pulse in the arm.

Symptoms often worsen with overhead activity—like reaching high for a hold or setting gear.

Repetitive overhead stress can be a contributing factor in thoracic outlet syndrome (TOS)
Repetitive overhead stress can be a contributing factor in thoracic outlet syndrome (TOS)

Diagnosis and Treatment

Diagnosing TOS can be tricky—it often mimics other conditions like carpal tunnel syndrome or rotator cuff injury. A physical therapist or sports medicine doctor who specializes in this condition will use a combination of history, clinical tests (like the Roos or Adson's test), and possibly imaging to confirm the diagnosis.

Conservative Treatment:

  • Mobility work: Thoracic spine, scalene, and pectoralis minor mobility.

  • Strengthening: Focus on scapular stabilizers (serratus anterior, lower traps, rhomboids).

  • Nerve glides: To gently mobilize the brachial plexus.

  • Activity modification: Adjust climbing volume, technique, and warm-up routines.


When Surgery Is Needed:

Surgical decompression may be necessary in rare, severe cases, especially for arterial or venous TOS. However, most climbers recover with conservative care.


Prevention for Climbers

The best treatment is prevention. Here's how climbers can protect themselves:

  • Cross-train: Include pulling and pushing exercises, shoulder stability drills, and antagonist workouts.

  • Warm up properly: Include dynamic mobility drills before climbing.

  • Stretch after sessions: Focus on the chest, neck, and shoulders.

  • Listen to your body: Don’t push through numbness or discomfort.


Final Thoughts

Thoracic Outlet Syndrome can sideline even the most seasoned climber if not addressed early. But with awareness, proper training balance, and attention to body mechanics, it’s absolutely manageable—and often preventable.

This can be a serious condition that can lead to blood clots if not treated appropriately. If you're experiencing arm numbness, tingling, or unexplained weakness after climbing, don’t brush it off. Consult a healthcare professional familiar with climbing-related injuries. Sometimes climbers can have a genetic predisposition to TOS, but it is certainly worth consulting with a healthcare professional if experiencing symptoms of TOS.


If you are experiencing arm heaviness/tightness, change of skin color, visible superficial veins on the shoulder and chest, and/or coldness in the arm or hand that does not go away quickly after climbing, contact your doctor immediately or go to the hospital to screen out a blood clot.



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