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Thoracic Outlet Syndrome

The thoracic outlet is a small passageway leading from the base of the neck to the armpit and arm. This small area contains many blood vessels, nerves and muscles. When this passageway becomes compressed, the condition is termed as thoracic outlet syndrome. This rare condition is characterized by burning pain in the neck and shoulder, numbness and tingling of the fingers, and a weak hand grip. Thoracic outlet syndrome generally occurs within the age group of 20 to 60 years and is more common in females than in males.

Types
There are 3 types of thoracic outlet syndrome namely neurogenic thoracic outlet syndrome, arterial thoracic outlet syndrome and venous thoracic outlet syndrome.

  • Neurogenic thoracic outlet syndrome: It is the most commonly occurring thoracic outlet syndrome that affects women. It is characterized by pain and numbness in the arms, neck, hand and head. Neurogenic thoracic outlet syndrome is caused due to the compression of the lower portion of the brachial plexus (bundle of nerves arising from the neck that controls sensation and movement of the arm) by bone or soft tissue abnormalities in the region of the lower neck.
  • Arterial thoracic outlet syndrome: Arterial thoracic outlet syndrome is caused by the compression of the subclavian artery (present in the chest region below the collar bone) by a cervical (neck) rib. It is the most serious, yet rare form that accounts for about 1% of all patients with thoracic outlet syndrome. Arterial thoracic outlet syndrome is characterized by aneurysm (bulging of an artery wall), muscle atrophy (muscle wasting), embolism and thrombosis (arterial blockage by blood clot), vasospasm (tightening and spasm in blood vessels) and gangrene (tissue death).
  • Venous thoracic outlet syndrome: It is caused by the compression of the subclavian vein and accounts for around 4% of patients with thoracic outlet syndrome. It is most commonly seen in young men. Venous thoracic outlet syndrome is characterized by edema (fluid retention in tissues), cyanosis (skin discoloration due to lack of oxygen to underlying tissue), claudication (pain due to reduced blood flow) and venous dilatation (expansion of veins).

Causes
Thoracic outlet syndrome can result due to the following:

  • Injury
  • Tumors that press nerves
  • Poor posture that compresses nerves
  • Weight lifting
  • Anatomical defects such as an elongated transverse process of one of the neck bones or tissue overgrowth

Symptoms
The symptoms of thoracic outlet syndrome may include numbness and pain in the neck, shoulder and arm, tingling or burning sensation, weakness, limited range of movement of the arms, swelling or redness of your arm, or color changes to the arm or hand.

Diagnosis
A proper diagnosis is essential for the treatment of thoracic outlet syndrome. To evaluate your condition, your doctor will perform a physical examination and collect your medical history. You may be advised to have a chest X-ray, MRI or CT scan. Your doctor may also recommend blood tests and an electromyogram (measures electrical activity of muscles) evaluation. Nerve conduction velocity study may be suggested to check the conduction of electrical signals in the nerves.

Treatment
The treatment of thoracic outlet syndrome involves both non-surgical and surgical approach.

Nonsurgical treatment

  • Physical therapy: Exercises can decrease the pressure on the nerves and blood vessels and also strengthen the muscles surrounding the shoulder. Maintaining proper posture can help you stand, sit and walk straight.
  • Non-steroidal anti-inflammatory medications: can reduce pain and swelling
  • Weight loss: reduce your weight, if you are overweight
  • Lifestyle changes: avoid strenuous activities and other activities that increase the risk or symptoms

Surgical treatment
If nonsurgical treatment does not alleviate your symptoms, your doctor may advise surgery. Surgery will depend on the cause of the compression, and may involve removing a portion of an abnormal first rib or releasing a muscle that joins the neck and chest.

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