Thoracic Outlet Syndrome

more about Thoracic Outlet Syndrome

Description

• The thoracic outlet is a space between the first rib and the collar bone (clavicle).  The nerves and vessels from the neck pass through this space on their way to the arms and hands.  Thoracic outlet syndrome is a condition characterized by pain, tingling and weakness in the upper extremities, caused by the compression of the nerves or/and vessels in this space.

Symptoms

• Pain in the neck, shoulders, arms and hands
• Tingling and numbness of the upper extremities
• Weakness and fatigue (pressure on motor nerves) of the upper extremities
• Swelling and coldness in the upper extremities due to compression of the vessels

• The symptoms may be triggered by the overhead position of the upper extremities

Cause

• Any condition resulting in the enlargement or movement of the surrounding tissues of the thoracic outlet can reduce this space and compress the nerves and vessels.
  
• Hyperextension neck injuries and repetitive overhead motions are the common causes of thoracic outlet syndrome.
  
• After clavicle fractures, the scar tissue resulting from the tear of scalene muscles can reduce the thoracic outlet.
  
• Other anatomical causes — bony abnormalities such as an extra-first rib and congenital fibromuscular bands

How the diagnosis is made

• The symptoms of thoracic outlet syndrome can mimic many other disorders, so the diagnosis is difficult.  Physical examination and tests are of the highest priority.  Neck or chest X-Rays may be helpful in detecting the extra-rib.  Electromyography and nerve conduction tests of the upper extremities can show evidence of nerve pinching in severe cases.  Some tests may be required to rule out other disorders that cause similar symptoms with thoracic outlet syndrome.

Similar Conditions

• Herniated cervical disc
• Carpal Tunnel Syndrome
• Rotator cuff tendonitis or tear
• Shoulder bursitis

• Cubital tunnel syndrome (Ulnar nerve pinching at elbow level)

Treatment

• The treatment depends on the severity of the symptoms
  
• An initial conservative approach to patients with thoracic outlet syndrome include the following measures:
  

1. 1. Stretching and strengthening exercises of the shoulder and neck muscles
   2. Weight loss relieves symptoms in obese patients
   3. Anti-inflammatory medications to relieve pain
   4. Changing positions and workstation, avoiding repetitive activities, postural exercise with frequent breaks (shoulder shrug exercise is an effective tool to relax the muscles around the thoracic outlet).

• If the conservative treatment fails and signs of neurovascular compression arise, surgery is recommended to release the nerves and vessels.