Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

The term thoracic outlet syndrome includes various compressions of the bundle of nerve vessels from the brachial plexus, subclavian artery and subclavian vein. These syndromes are among the neurovascular diseases and are expressed in neurological symptoms as well as those of the blood flow. The compression point of the mesh can be permanently resolved therapeutically.

What is thoracic outlet syndrome?

The neurovascular syndromes are a group of diseases that simultaneously show neurological symptoms and pathological circulatory processes. Most of these syndromes are among the compression diseases and are due to a jamming of nerve-vascular networks, as they occur in the body of every human being. A clinical picture from this group is the thoracic outlet syndrome. For what does kauda syndrome stand for, please visit ezhoushan.net.

This subset of neurovascular syndromes includes multiple manifestations that result in compression of the neurovascular network of the brachial plexus, subclavian artery, and subclavian vein. The most important manifestations of the group are hyperabduction syndrome, pectoralis minor syndrome, Paget von Schroetter syndrome and costoclavicular syndrome.

In thoracic outlet syndrome, the vascular bundle of nerves can be temporarily or permanently compressed. The beach stretches along the neck towards the extremities and has to overcome various bottlenecks on its way. In particular, the anterior and posterior scalene gaps, the costoclavicular space between the rib and collarbone, and the coraco-pectoral space between the coracoid process and the pectoralis muscle. The strand can jam at each of these bottlenecks. The symptoms depend on the location of the compression.

Causes

The vascular nerve cord of the arm can become jammed at three narrow points. Compression of structures at these sites is the primary cause of thoracic outlet syndrome. The jamming in the scalene gap corresponds to the scalene syndrome. This sub-form of the syndrome is favored by existing cervical ribs, by exostoses or the steep position of the upper ribs, as well as by hypertrophy of the scalenus muscles.

With the latter cause, the syndrome is known as scalenus anterior syndrome. Thoracic outlet syndrome due to a cervical rib is called cervical rib syndrome. If there is an obstruction in the costoclavicular space, the thoracic outlet syndrome is present in the form of a costoclavicular syndrome. This phenomenon occurs mainly after clavicle fractures, which can cause excessive callus formation.

Compression can also occur in this area when the arm is in maximum abduction. If the cause of thoracic outlet syndrome is entrapment of the neurovascular bundle in the coraco-pectoral space, either hyperabduction syndrome or pectoralis minor syndrome is present. The symptoms are usually due to hypertrophy of the pectoralis minor muscle.

In some cases, the thoracic outlet syndrome is also associated with causative Pancoast tumors. A special form of thoracic outlet syndrome is present when the bundle of vascular nerves is jammed in narrowing of the subclavian vein.

Symptoms, Ailments & Signs

The clinical symptoms of thoracic outlet syndrome vary with the location of the obstruction. Because the vessels are pinched, obstructions to blood flow occur. These circulatory disorders can become noticeable, for example, when the arm becomes heavy and cold. The limb falls asleep, loses color or reddens in certain places.

The special form of thoracic outlet syndrome can also cause venous outflow disorders and thus cause thrombosis such as those in Paget-von-Schroetter syndrome. The neurological symptoms of the syndrome begin with mild sensory disturbances and end with signs of paralysis of the entire arm. Both the sensory and motor nerves of the arm can be jammed in the bottlenecks described.

If only sensory nerves are affected by compression, a feeling of numbness occurs. Under certain circumstances, other sensory disturbances such as a disturbed hot-cold sensation or an abnormal sensation of pain may also occur. If motor nerves are affected in addition to the sensory nerves, this usually manifests itself in movement disorders.

The muscles only contract weakly and muscle tremors can occur. The depth sensitivity can be disturbed, which results in reduced movement and strength coordination. Remitting symptoms and thus temporary congestion are present when the symptoms recede as soon as the patient changes posture.

Diagnosis & course of disease

A suspected diagnosis of thoracic outlet syndrome can already be made after the anamnesis. The doctor can then trigger the symptoms in a provocation test and thus secure the suspected diagnosis. The most important tests in this context are the fist test and the Adson test. The diagnosis also includes X-rays of the thorax and cervical spine.

The imaging can be used to search for the exact cause of the jam and the phenomenon can be assigned to a subtype. The doctor uses electroneurography to detect damage to the nerve lines in the affected area. The depiction of the vascular perfusion in different positions of the arm in the context of a duplex sonography serves to confirm the diagnosis. Patients with thoracic outlet syndrome generally have an excellent diagnosis. Complications such as thrombosis are more of a special case.

Complications

First and foremost, those affected with thoracic outlet syndrome suffer from severe circulatory disorders. This can lead to sensory disturbances or even paralysis, which make everyday life of the person affected significantly more difficult. The extremities in particular are affected by the disorders, so that they tingle or fall asleep. The color of the skin can also change.

In most cases, paralysis due to thoracic outlet syndrome is temporary. The sense of temperature may also be disturbed, so that the person concerned can injure himself more easily or cannot correctly assess dangers. Furthermore, if left untreated, movement disorders and muscle tremors can occur. If the thoracic outlet syndrome is not treated, the paralysis can also occur permanently in the worst case.

As a rule, the symptoms of thoracic outlet syndrome can be relieved relatively easily with repositioning of the body or the affected body region. However, in some cases, surgical interventions and various therapies are necessary to limit the symptoms. Complications usually do not arise. Life expectancy is also not restricted or reduced in most cases.

When should you go to the doctor?

Thoracic outlet syndrome should always be treated by a doctor. In this case, no self-healing can occur, so that the person concerned is always dependent on a medical examination with subsequent treatment. This is the only way to prevent further complications. The doctor should be consulted for thoracic outlet syndrome if the person concerned suffers from circulatory disorders. These disorders can occur in different parts of the body and have a very negative effect on the quality of life of those affected. Furthermore, strong signs of paralysis can indicate the thoracic outlet syndrome. Those affected suffer from movement disorders and muscle problems.

This leads to tremors and severe pain in the muscles, which can also occur without exertion. If these symptoms occur, the thoracic outlet syndrome must be examined by a doctor in any case. The thoracic outlet syndrome can be recognized by a general practitioner. The further treatment then depends on the exact type and severity of the symptoms and is carried out by a specialist.

Treatment & Therapy

Thoracic outlet syndrome does not require further treatment in all cases. If the symptoms are only temporary and also mildly pronounced, no therapy is necessary. If the patient still wants to prevent the occurrence, he receives tips on preventive positioning of the arms and body. In the case of more pronounced symptoms, either conservative or surgical therapy is carried out.

Intervention in the case of permanent compression is particularly important, since such phenomena can result in the death of nerve cells in addition to tissue ischemia. The conservative therapy path is usually only suitable for less pronounced disease manifestations and consists mainly of physiotherapeutic steps.

In addition to manual grips, active exercises to strengthen the shoulder girdle and massages of the region, the conservative therapy method also includes heat applications that cause the muscles to relax. In the case of a pronounced thoracic outlet syndrome, the surgical measures correspond to an invasive removal of the causative constriction. This elimination may correspond, for example, to the removal of a cervical rib. Physiotherapy follows the operation.

Prevention

Various forms of thoracic outlet syndrome can be prevented by posture training and relaxation techniques, which result in relaxation of the muscles and thus a reduction in any constrictions.

Aftercare

The follow-up treatment of a thoracic outlet syndrome depends on the type of treatment and on the secondary diseases that have arisen as a result of the thoracic outlet syndrome. Surgical treatment of thoracic outlet syndrome should always be followed by intensive rehabilitating physiotherapy. The focus is on remobilizing the shoulder and restoring the normal functionality of the shoulder and shoulder girdle muscles.

Accordingly, physiotherapy should consist of heat treatments, massage treatments and exercises to strengthen the muscles. If the thoracic outlet syndrome has been completely cured, no further follow-up treatment is required. If chronic pain persists even after treatment of the thoracic outlet syndrome, additional pain therapy can be considered.

In addition to the administration of painkillers, this also includes physiotherapeutic measures that should reduce the pain in the muscles, arms and shoulders by increasing mobility. In the case of persistent pain after treatment of a thoracic outlet syndrome, however, pain relief must primarily be provided by medication.

If necessary, the use of opioids (tilidine) can be considered here. In this case, the liver and kidney function values ​​must also be checked regularly in the blood in order to be able to detect a reduction in organ activity resulting from the therapy with the opioids at an early stage and to be able to take countermeasures. In addition, alcohol consumption must be avoided for life in this case, as it can also damage the liver and kidneys.

You can do that yourself

The therapy of the thoracic outlet syndrome can be supported by a number of measures. Physiotherapeutic treatment is accompanied by appropriate gymnastics. The sports medicine doctor or physiotherapist can suggest suitable exercises to strengthen the shoulder girdle muscles. Physical activity can be gradually increased as long as the thoracic outlet syndrome heals as desired.

Massages are used to relax the muscles. Patients can massage themselves or seek professional massage to relieve discomfort. In addition, heat applications counteract the hardening. The doctor must monitor the self-help measures.

If the symptoms are severe, an operation is necessary. After the surgical removal of the constriction, physiotherapeutic measures are also indicated. The typical general measures such as rest and monitoring of the surgical wound also apply. If inflammation, bleeding or pain is noticed, the doctor must be consulted.

Finally, in the case of thoracic outlet syndrome, possible amplifiers must be eliminated. Malpositions often develop, which can lead to joint wear and other complications in the long term. These physical problems must be corrected as part of physiotherapy. The patient can in turn support the physiotherapy with targeted training of the affected regions at home.

Thoracic Outlet Syndrome