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When you lift your arms above your head, gravity works against venous return, making it harder for blood to flow back to the heart. To overcome this, the body relies on muscle contractions and one-way venous valves, which help push blood upward and prevent it from flowing backward. This efficient system ensures that blood continues to circulate properly even when the arms are elevated.

However, in some cases, this natural process is disrupted — as seen in Vascular Thoracic Outlet Syndrome (vTOS).

vTOS occurs when major blood vessels, particularly the subclavian vein or artery, become compressed in the thoracic outlet, a narrow space between the collarbone (clavicle) and the first rib. This compression may be due to anatomical abnormalities (such as a cervical rib), trauma, poor posture, or repetitive overhead movements.

Over time, this can impair blood flow to the arm and hand, leading to a range of vascular symptoms. These include:

Swelling, pain, and numbness, especially in the fingers and hand

A cold sensation, heaviness, or bluish/purplish discoloration of the limb

Symptoms that worsen when the arms are raised or used overhead

If untreated, vTOS can lead to serious complications like blood clots or chronic venous obstruction, making early diagnosis and treatment essential.