Thoracic outlet syndrome is a constellation of symptoms that occur when there is compression at the upper outlet of thoracic (chest) cavity. The compression affects the neurovascular bundle coursing between the collarbone and first rib. This compromises the blood and nerve supply to the arms. Common causes are physical trauma, work-related or sports-related injuries, anatomical defects, and also pregnancy.
Symptoms vary depending on which structure is being pressed upon the most, whether nerves or blood vessels. There will be pain in neck and shoulders. Fingers will become numb. In long-standing cases there can be wasting of muscles in the hand. Treatment involves pain relief and physical therapy. Sometimes, you may need to undergo surgery.
Causes Of Thoracic Outlet Syndrome
There are several causes for this syndrome. However, sometimes the cause is not clear. There are three main types of causes: birth abnormalities, trauma or stress, and poor posture.
Congenital abnormalities mean abnormalities present from birth. Such abnormalities that can cause it include extra rib above first rib, longer transverse process of the seventh neck vertebra (in your spine), anomalies of muscles and connective tissue (tighter fibrous band connecting the spine to ribs).
Physical Trauma Or Stress
Physical trauma can cause realignment of structures, leading to compression on blood vessels and nerves in that region.
Such trauma can include whiplash injury (in a car accident), repetitive strain due to certain work-related activities (such as repeated typing, constant lifting of things above the head), and sports injuries. Pregnancy can cause repetitive stress injuries.
Being overweight or obese can lead to poor posture. Poor posture in turn puts extra pressure on the upper outlet of chest. Other poor postures that can cause this syndrome include rounding or hunching over the back, and drooping of shoulders.
Symptoms Of Thoracic Outlet Syndrome
The symptoms vary depending on the type of thoracic outlet syndrome. There are three such types: neurogenic (related to nerves), vascular (related to blood vessels), and nonspecific. However, in all types the symptoms are confined mainly to the upper limbs.
These symptoms occur due to compression on the brachial plexus. Brachial plexus is the nerve bundle passing through the upper outlet of thorax. Almost 95% of cases have neurological symptoms.
These symptoms include pain in shoulders and neck, aching in the arms, aching in the hand, tingling and numbness in fingers, weakening of grip, and wasting away of hand muscles.
Vascular symptoms occur due to compression of either subclavian artery or subclavian vein. The compression reduces the blood flow to the upper limb and causes the vascular symptoms. They include pain and swelling of arm, loss of colour of hand and fingers, weak pulse, throbbing lump near collarbone, and tiny black spots due to blood clots in hand and fingers.
Combination Of Neurological And Vascular Symptoms
In some cases, the cause of thoracic outlet syndrome is not identifiable. In such cases, there may be a combination of the neurological and vascular symptoms mentioned above, such as ache or pain in shoulders and arms or around collar bone and upper chest.
Treatment Of Thoracic Outlet Syndrome
Most cases respond well to conventional treatment with physical therapy and medications. Only a small group of patients require surgery to relieve the symptoms.
Medications are needed mainly to relieve the pain and relax the muscles. Medication needs to be combined with physical therapy to be effective. Such medications are analgesics like ibuprofen, muscle relaxants and blood thinners.
Physical therapy attempts to open up the narrow outlet, and thereby reduce the compression on the nerves and blood vessels. It also helps in strengthening the muscles in the region to help maintain good posture. The exercises can be done with or without weights. They involve stretching and range of motion exercises.
Surgery is necessary if you are not responding to the conventional measures discussed above. It is also indicated when there are symptoms of blood clots and muscle wasting. Sometimes, surgery is indicated to diagnose and treat when the cause is not clear.
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