What Is the Thoracic Outlet?
The thoracic outlet mentions the space between the clavicle and the first rib bone. This narrow passageway of the thoracic outlet is populated with blood vessels, nerves, and other muscles. The neurovascular bundle comprises the thoracic outlet subclavian vein, subclavian artery, and brachial nerve plexus.
The condition mainly affects athletes, gymnastics people, and others who are too involved in sports. Also, the neurogenic type being the common form, can affect middle-aged women.
What Is Thoracic Outlet Syndrome?
The term thoracic outlet syndrome refers to a group of disorders. It occurs when there is an injury, compression, and irritation to the nerves and blood vessels. The pain will be felt in the shoulders and neck, and a tingling sensation in the fingers. Thoracic outlet syndrome is named after the space between the neck and upper chest. There will be a grouping of nerves and blood vessels.
What Are the Different Types of Thoracic Outlet Syndrome?
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Neurogenic Type: Neurogenic thoracic outlet syndrome occurs when the nerves leading from the neck are getting compressed. Most of the cases come under this type.
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Venous Type: This type occurs when a vein is compressed. This leads to upper body thrombosis. A minor percentage of people come under this type.
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Arterial Type: This type occurs when an artery is compressed. It is also known to occur in a few people.
What Are the Causes of Thoracic Outlet Syndrome?
Thoracic outlet syndrome can be due to different factors. They are:
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Congenital abnormalities.
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Trauma such as whiplash injury, and car accidents.
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Strain: This can be seen more in swimmers and volleyball players.
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Rare tumors such as osteomyelitis.
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Poor posture: The collarbones can slip out of place and cause pressure on the nerves. Drooping of the shoulders might be seen in such conditions.
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Pregnancy: Loosening of muscles might occur during pregnancy.
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Physical defects: Few people have an extra rib by birth.
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Obesity: Excess weight can put more stress on the muscles that are known to support the collarbone.
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Repeated activities might include typing on the computer, lifting heavy objects, etc.,
What Are the Symptoms of Thoracic Outlet Syndrome?
The symptoms of thoracic outlet syndrome vary according to the type.
Symptoms of the neurogenic type are:
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Pain in the shoulder and arms.
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Weakness.
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Tingling sensation in the fingers.
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Discomfort in the fingers.
Symptoms of venous type:
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Edema in the arms, hand, and fingers.
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The hand and arm change to a bluish color.
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Tingling sensation in the hands.
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Veins become more prominent in the shoulder, neck, and hands.
Symptoms of arterial type:
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There might be coldness, numbness, and pain in the arms and hands.
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This might cause a whitish appearance on the hands.
When Should One See a Doctor?
A patient should consult a doctor if they experience any symptoms of thoracic outlet syndrome. The patient should take more care if it lasts for several weeks. Before the worsening of symptoms, contact a doctor immediately.
How Is Thoracic Outlet Syndrome Diagnosed?
For diagnosis, the doctor will perform a physical examination. The medical history of the patient might be necessary. Provocation tests can be used to evaluate the condition. These tests are meant to replicate the symptoms one is facing so that the doctor can make a faster and easier diagnosis, and are done in different positions. The physical tests involve movement-based tests, such as the elevated arm stress test, and the upper limb tension test, in which one needs to lift their arms, tilt their heads, and clench the fist.
The doctor may also ask to perform an additional test in order to confirm the diagnosis.
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An X-ray of the thoracic region can be a good diagnostic tool. It can reveal the presence of an extra rib.
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Electromyography: It helps to locate the muscles and nerves in the thoracic outlet.
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An MRI imaging technique uses powerful magnets and radio waves. This helps to make detailed images of the thoracic outlet. These pictures can determine the location and etiology of the compression. Any structural abnormalities can also be identified.
What Are the Treatment Options for Thoracic Outlet Syndrome?
The treatment for thoracic outlet syndrome aims to relieve the symptoms and pain. Both medications and surgical options are available. In mild cases, medications can be helpful. But in severe cases, surgery might be required.
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Medications: Treatment for thoracic outlet syndrome starts with medications. These medications can ease the symptoms. Over-the-counter medications, such as Naproxen and Ibuprofen, are available. These may be used to reduce inflammation and pain. Some thrombolytic drugs are used to dissolve clots in veins or arteries. Anti-coagulants can also be used.
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Exercise: Ideal methods of physical therapy are recommended. This helps to strengthen the shoulder muscles. Physical therapy exercises reduce the pressure in blood vessels and nerves. The doctor may recommend a weight-loss program if the patient is overweight. Excess body weight can increase the pressure on the joints. Go to the gym and follow a weight loss regime. Before trying out any thoracic outlet syndrome exercise, it is necessary to ask the doctor for modifications in the exercises according to the one's physical condition.
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Surgery: The patient may be in need of surgery if the symptoms do not improve with the initial form of treatment, such as medication and physical therapy. Surgical procedures for thoracic outlet syndrome involve removing an extra rib from the set of rib bones. Rerouting of blood vessels can also be done. Angioplasty can be done to inflate the narrowed vessels.
Conclusion:
Thoracic outlet syndrome, if left untreated for many years, can cause permanent neurological damage. It is important to check the symptoms early so that treatment can be started as soon as possible. Avoid repetitive movements if the patient has a doubt of having thoracic outlet compression. Lifting heavy objects should also be avoided. If someone has a high BMI, they should perform appropriate exercises. Even if a person does not have symptoms of thoracic outlet syndrome, do not carry heavy bags over the shoulder. One should stretch the body daily. Perform exercises that will protect the shoulder muscles from thoracic outlet syndrome.
