Thoracic Outlet Syndrome
What is the thoracic outlet syndrome?
Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit. The thoracic outlet is surrounded by muscle, bone, and other tissues. Any condition which results in enlargement or movement of the tissues of or near the thoracic outlet can cause the thoracic outlet syndrome. These conditions include muscle enlargement, injuries, an extra rib from the neck at birth (cervical rib), and tumors at the top of the lung (rare). Often no specific cause is found.
It is felt by some researchers that the evolution of the torso of primates from a four-legged to a two-legged position may predispose humans to the development of thoracic outlet syndrome. The resulting vertical posture produced flattening of the chest cage and a shift of the shoulder joint backwards, both of which narrowed the thoracic outlet.
What are symptoms of thoracic outlet syndrome?
Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration). Often symptoms are reproduced when the arm is positioned above the shoulder or extended. Patients can have a wide spectrum of symptoms from mild and intermittent, to severe and constant. Pains can extend to the fingers and hands, causing weakness.
How is thoracic outlet syndrome diagnosed?
The diagnosis of thoracic outlet syndrome is suggested by the symptoms and supported by findings of the doctor during the examination. Certain maneuvers of the arm and neck can produce symptoms and blood vessel "pinching" causing a loss of pulse. Further supportive testing can include electrical tests, such as EMG and somatosensory evoked responses (although these may not be positive in all patients). Some patients can have angiogram x-ray tests that demonstrate the pinched area of the blood vessel involved.
What is the treatment for thoracic outlet syndrome
Treatment of the thoracic outlet syndrome can usually be conservative and involve a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for the thoracic outlet syndrome and their evaluation of the patient can be helpful. Shoulder shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet.
Patients should avoid prolonged positions with their arms held out or overhead. For example, it is best to avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on your stomach with their arms above the head. They should also not repetitively lift heavy objects.
Some patients with severe, resistant symptoms can require surgical operations to open the thoracic outlet. These include removal (resection) of the first rib in order to spare the affected nerve and blood vessels from ongoing compression.
Author: William C. Shiel Jr., MD, FACP, FACR
How to Order | Price
List | Refill Orders
Home |
About Us | Contact
Us | FAQ
Buy cheap canadian prescriptions from a Canadian Internet Pharmacy leader.
cheap online pharmacy canadian pharmacy prescription drugs online discount medicine pharmacies
online mail order prescription medication canadian online pharmacy search for online drugs
canada pharmacies discount canadian medication drugstore Plavix Fosamax Lipitor Celebrex
Actonel Flomax Glucophage Premarin Prevacid Evista .
|
