Description

Thoracic Outlet Syndrome

Thoracic outlet syndrome is a group of diseases caused by
compression of blood vessels or nerves in the space between the collarbone and
the first rib (thoracic outlet). This can cause pain in the shoulder and
neck area and numbness in the fingers.
Common causes of thoracic outlet syndrome include falls, physical trauma from a
traffic accident, repetitive injuries from activities such as work or sports,
some anatomical defects (such as excess ribs), and pregnancy. Sometimes
the cause of thoracic outlet syndrome is not specified.
• Women are more likely to be diagnosed with thoracic outlet syndrome than men.
• Thoracic outlet syndrome is more common in young adults between the ages of
20 and 40.

Thoracic outlet syndrome is usually treated with physical
therapy and pain relief. However, in some cases, the complaints cannot be
solved with this medical treatment, and the thorax outlet is enlarged with
surgery to remove the pressure on the blood vessels and nerves.
Symptoms and Complaints
• Neurogenic Thoracic outlet syndrome. This form of thoracic outlet
syndrome is characterized by compression of the brachial plexus. The
brachial plexus is a network of nerves that comes from your spinal cord and
controls muscle movements and sensations in your shoulder, arm, and
hand. In most cases of thoracic outlet syndrome, symptoms are neurogenic.
• Vascular Thoracic outlet syndrome. This type of thoracic outlet syndrome
occurs when one or more veins (venous thoracic outlet syndrome) or arteries
(arterial thoracic outlet syndrome) are compressed under the collarbone
(clavicle).
• Nonspecific (controversial) thoracic outlet syndrome. People with
nonspecific type of thoracic outlet syndrome have chronic pain at the thoracic
outlet site that worsens with activity, but no specific cause of the pain can
be identified.
Symptoms of thoracic outlet syndrome may vary depending on which structures are
compressed
. When nerves are compressed, signs and symptoms of neurological thoracic
outlet syndrome are: • Loss of muscle in the fleshy base of your thumb
(Gilliatt-Sumner’s hand)
• Numbness or tingling in your arm or fingers.
Pain in your neck, shoulder, or hand
Poor, weak grip
Signs and symptoms of vascular thoracic outlet syndrome may include:
• Color changes in your hand (bluish color)
• Arm pain and swelling, possibly due to blood clots
• Blood clot in veins or arteries in the upper part of your body
• Paleness in one or more of your fingers or in your whole hand
• Weak or no pulse in the affected arm
• Cold fingers, hands or arms
• Arm fatigue with activity
• Numbness or tingling in your fingers
• Arm or neck weakness
• Painful swelling near the collarbone
If your symptoms are not treated early, it can lead to progressive nerve damage
and surgery may be required. Therefore, early evaluation of your symptoms
and elimination and treatment of the problem should be done as soon as
possible.
If you have thoracic outlet syndrome complaints, avoid constantly repetitive
movements and do not lift heavy objects. Avoid carrying heavy bags or bags
on your shoulder, even if you have no symptoms of thoracic outlet
syndrome. If you are overweight, you can prevent or relieve symptoms
associated with thoracic outlet syndrome by losing weight.
Do stretching and strengthening exercises daily to keep your shoulder muscles
strong.
Diagnosis Diagnosing
thoracic outlet syndrome can be difficult. Symptoms and severity of the
disease can vary greatly from patient to patient.
Provocation tests
Provocation tests are tests to increase the symptoms and signs of the disease.
• X-ray.
• Color Doppler Ultrasonography
• Computed tomography (CT) scanning. It can specifically determine the
location and cause of blood vessel (vascular) compression.
• Magnetic resonance imaging (MRI). Identifying the location and cause of
blood vessel (vascular) compression is superior in revealing congenital
anomalies, such as a fibrous band that connects your spine to your bone or a
cervical rib.
Arteriography and venography.
• Electromyography (EMG).
• Nerve conduction study. These tests use a small amount of electrical
current to test and measure your nerves sending impulses to muscles in
different parts of your body. This test can determine if you have nerve damage.
Therapy
• Physical Therapy. It is the gold standard treatment for neurogenic
thoracic outlet syndrome. lyre.
• Anti-inflammatory, Myelorexan, anticoagulant
• Surgery: If your complaints continue or even increase despite all treatments,
surgical treatment should be considered if you experience progressive
neurological damage or vascular occlusion. Thoracic decompression can be
performed using several different surgical approaches.
• Transaxillary approach In this surgery, your surgeon makes an incision in
your chest to access the first rib, divides the muscles in front of the rib,
and removes part of the first rib to reduce compression. This approach
provides easy access to the first rib without touching the plexus brachialis
nerves or blood vessels. 1. By removing the entire rib, the thoracic
outlet is relieved.
• Supraclavicular approach. This approach is especially preferred in the
vascular thoracic autlet treatment.
• Infraclavicular approach. This surgical technique can be used in the
treatment of thoracic outlet syndrome that requires extensive vascular repair.