Does thoracic outlet syndrome always effect the hand?

Yes, are frequently: The compression of the brachial plexus, subclavian – axillary arteries and veins generate what is called the thoracic outlet syndrome. Symptoms related to the neurological component are very frequent; and are mainly related to the distal upper extremities such as the hands and forearms. In summary I would say symptoms affecting the hand and very frequent, probably in the range of 90 – 95 %

Not Always: Thoracic outlet syndrome may involve both nerves and or vascular structures so the symptoms vary. Most people do experience some symptoms in the hand or fingers but some only get symptoms in the arm at times. Best to have an evaluation as early on physical therapy may be helpful an prevent the need for surgery.