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A variety of other conditions can produce signs and symptoms that may be confused with thoracic outlet syndrome (TOS) and must be ruled out before a diagnosis of TOS can be established:

• Herniated disk
• Carpal tunnel syndrome
• Cervical spine disease with nerve root compression
• Pancoast's tumors - a type of lung tumor that grows in the thoracic region
• Spinal cord tumors
• Degenerative spinal cord diseases (e.g., multiple sclerosis, syringomyelia)
• Other neuropathies (e.g., cubital tunnel syndrome, radial tunnel compression)
• Tumors of the brachial plexus
• Inflammatory diseases of the shoulder (e.g., tendonitis, arthritis)
• Complex regional pain syndrome (e.g., RSD)
• Vascular diseases (e.g., atherosclerosis, thrombophlebitis)

When symptoms develop in a patient with thoracic outlet syndrome, they typically appear after exercise or arm movement. The timing of appearance of symptoms differentiates TOS from:

• Orthopedic shoulder problems where pain is usually felt during physical activity, but not after the cessation of activity.
• Herniated cervical disk which usually causes constant but not intermittent pain. Also, disk-related pain typically follows the radial nerve distribution route whereas pain from TOS usually involves the entire limb.

• Carpal tunnel syndrome

  • median nerve compression at the wrist causes numbness and pain in the arm, but usually not the fingers. TOS does not involve the median nerve.
  • pain typically originates in the hand
  • pain radiates up the arm but not down the arm
  • patients often report muscle cramping of the hand and forearm
  • pain is brought on by prolonged grasping of the hand or fingers (e.g., holding a steering wheel, sewing, or writing), but not by use of the entire arm.

The pain from thoracic outlet syndrome is usually in the neck and shoulder area, and moves down the arm towards the hand. There is no cramping associated with TOS and pain is provoked by elevation of the arm.