INFORMATION ON THORACIC OUTLET SYNDROME

Thoracic outlet syndrome consists of a group of distinct disorders that affect the nerves in the brachial plexus and various nerves and blood vessels between the base of the neck and axilla. For the most part, these disorders are produced by positional compression of the subclavian artery and vein, the vertebral artery, and the nerve cords of the brachial plexus. The disorders are complex, somewhat confusing, and poorly defined, each with various signs and symptoms not only arising from the upper extremity but also from the chest, neck and head. The chest pains can mimick anginal pain. Thoracic outlet syndrome is a combination of pain, numbness, tingling, weakness, or coldness in the upper extremity caused by pressure on the nerves and/or blood vessels in the thoracic outlet.

SYNONYMS OF THORACIC OUTLET SYNDROME

Synonyms and related keywords:
1) Vascular thoracic outlet syndrome.
2) Neurologic thoracic outlet syndrome.
3) Arterial thoracic outlet syndrome.
4) Venous thoracic outlet syndrome.
5) Compression of neurovascular structures.

CAUSES OF THORACIC OUTLET SYNDROME

A person's physical makeup also can cause thoracic outlet syndrome and compression is evident- an extra first rib or an old fracture of the clavicle, which reduces the space of the outlet. Also compression of the nerves and arteries of the arm in the Thoracic Outlet.

Others may be:

1) Disc protrusion, herniation or degeneration causing nerve impingement.
2) Brachial plexus entrapment or subclavian artery compression in the interscalene triangle.
3) Impingement at the cervico-axillary canal or the costo-clavicular space -could be from carrying a heavy shoulder bag or bad posture.
4) Fibrositis of the cervical and shoulder area.
5) Cervical spondylosis -irritation or compression of the C3-C8 spinal nerves causing increased tension and spasm in anterior scalene muscles.
6) Bone spurs on cervical vertebrae.
7) Trauma such as whiplash or other injury to the neck that results in scar tissue formation in scalenes which lead to compression.
8 ) Old fractures of the clavicle that limit space for vessels.

SYMPTOMS OF THORACIC OUTLET SYNDROME

Symptoms of Thoracic Outlet Syndrome include pain, numbness and tingling, weakness and fatigue or swelling and coldness in the arm and hand . The symptoms can mimic many other conditions, such as a herniated disk in the neck, carpal tunnel syndrome, and even bursitis of the shoulder.

Others are as given:

1) Paresthesia of the hand most commonly little finger, medial forearm and arm; Pins and needle feeling.
2) Weakness in trapezius, Swelling or puffiness in arm or hand.
3) Bluish color in hand, coldness in hand and fingers due to loss of circulation: insufficient blood supply due to compression of subclavian artery.
4) Muscles in hand atrophy in chronic conditions.
5) Edema/swelling in hand caused by compression of subclavian vein.

DIAGNOSIS OF THORACIC OUTLET SYNDROME

Diagnosis of Thoracic Outlet Syndrome can be difficult and frustrating. The history and physical examination can be suggestive of Thoracic Outlet Syndrome, but frequently the symptoms are vague and difficult to track down. A chest x-rays may show an extra cervical rib, and be helpful in the diagnosis. Electrical tests of the arm and special tests to check whether or not the blood vessels that run with the nerve may be required to confirm the diagnosis. Many times all of this test are negative and the symptoms and examination must be relied on to make the diagnosis

TREATMENT OF THORACIC OUTLET SYNDROME

Treatment for individuals with Thoracic Outlet Syndrome varies depending on the type. True Neurologic Thoracic Outlet Syndrome is generally effectively treated with surgery. Treatment may include drugs such as analgesics, and physical therapy to increase range of motion of the neck and shoulders, strengthen muscles, and induce better posture. The treatment for Thoracic Outlet Syndrome is conservative, and does not usually involve surgery. Physical therapy can help strengthen the muscles surrounding the shoulder so that they are better able to support the collarbone. Postural exercises can help you stand and sit straighter, which lessens the pressure on the nerves and blood vessels. Nonsteroidal anti-inflammatory drugs, like aspirin or ibuprofen, can ease the pain.