When the blood vessels or nerves in between the collarbone and the first rib are compressed, a group of disorders occur called Thoracic Outlet Syndrome.
It is a common cause of pain in shoulder and numbness of fingers. Causes may range from physical trauma to pregnancy.
Treatment requires in this case may be physiotherapy, pain relief medications and surgery.
Signs and symptoms of thoracic outlet syndrome vary depending on its cause.
There are three types of thoracic outlet syndrome depending on the weather blood vessels got compressed or nerves are compressed.
It is characterized by compression of brachial plexus which is a network of nerves controlling muscles movements and sensation in shoulder, arm and hand. Signs and symptoms of neurogenic thoracic outlet syndrome include:
In which one or more blood vessels under the collar bone are compressed. Signs and symptoms include:
Which is quite controversial since some doctors say it doesn’t exist while other say that it is a common disorder. People with this disorder experience chronic pain and inactivity.
The cause of thoracic outlet syndrome is compression of nerves or blood vessels in the space between collar bone and 1st rib.
The following are causes of compression:
Diagnosis of thoracic outlet syndrome is difficult because symptoms vary depending on the type and severity of the disease.
The following diagnostic methods are used:
Doctor will perform physical examination to look for
History of illness also helps in diagnosis of the condition effectively.
In this doctor asks to move arms, neck or shoulders in various positions. Doctor will assess symptoms by examining patient in different positions.
X- ray of the affected area which will reveal the presence of extra rib. Ultrasound can be helpful to identify vascular thoracic syndrome and other vascular syndromes. Computerized tomography a dye may be injected into vein to view blood vessels in greater detail.
Magnetic resonance imaging can be used to locate and cause blood vessel compression. MRI may also reveal congenital anomalies. Magnetic resonance imaging is most commonly used diagnostic test used to diagnose thoracic outlet syndrome.
Arteriography and venography is done by inserting a thin tube through small incision through the groin and the catheter is moved through major arteries. The doctor injects a dye through the catheter to show x-ray images.
Electromyography is a procedure in which the doctor inserts a needle electrode through skin into various muscles and electrical activity of muscles is tested.
Nerve conduction study is a study used to evaluate the nerves ability to send impulses to muscles in different areas of the body.
Conservative therapy is opted to treat thoracic outlet syndrome.
Additional treatment options may include:
Neurothoracic outlet syndrome can be treated with physical therapy by performing some exercises and improving the range of motion.
Anti-inflammatory medications such as
If conservative therapy is not effective, surgery is recommended. Thoracic outlet syndrome surgery has many complications and may not relive symptoms completely.
Transaxillary approach in which an incision is made near the 1swt rib and remove portion of rib to relieve compression. Supraclavicular approach is used to repair compressed blood vessels. Surgeon makes an incision under the neck to expose brachial plexus and removes the muscles causing compression.
In some cases, 1st rib can also be removed. Infraclavicular approach in which an incision is made under the collar bone. This procedure is used to treat compressed veins.
In venous or arterial thoracic outlet syndrome, surgeon may deliver medications to dissolve blood clots.
There is no exact method to prevent thoracic outlet syndrome.
If thoracic outlet syndrome is untreated for years, it can cause permanent damage to the nervous tissue.
If a person belongs to the risk groups of thoracic outlet syndrome, avoid repetitive movements and lifting heavy object.
If a person is obese, losing weight will reduce the signs and symptoms.
Even if the person is not diagnosed with thoracic outlet syndrome or is not susceptible to the disease, he or she must avoid to carry heavy bags.
Lifestyle modifications are necessary in order to cope with thoracic outlet syndrome.
Symptoms associated with thoracic outlet syndrome can be caused by a number of other condition which makes it difficult for diagnosis.
Many people experience thoracic outlet symptoms years before they are actually diagnosed which can cause stress and frustration.
Concerns must be discussed with doctors if symptoms persist and diagnosis hasn’t been confirmed.
Doctors or physical therapists will instruct some exercises at home to strengthen the muscles and joints surrounding thoracic cage.
In addition, some of the following things are recommended:
Some of the following factors can increase the risk of having thoracic outlet syndrome:
Doing same action again and again can cause thoracic outlet syndrome. Some sports which require repeated actions are
Some occupations also require repetitive motions.
During pregnancy joint loosen up and lead to this disease.
Increases weight can put pressure on joints leading to compression. If treatment was not given in the early stages, progressive nerve damage can occur leading to requirement of surgery.
Surgery has higher risks than other treatment methods and may not treat the conditions always.
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