Thoracic outlet syndrome

Thoracic Outlet Syndrome


Thoracic outlet syndrome


In this article, I am going to talk about thoracic outlet syndrome. What is it, what are the causes and risk factors, symptoms, or types of thoracic outlet syndrome and how to treat this condition?


The thoracic outlet is the ring formed by the top ribs, at the bottom of the collarbone. In this condition, there is compression of nerves or blood vessels by the rib, collarbone or neck muscles at the top of the outlet. The boundaries of the thoracic outlet are marked by scalene muscle anteriorly, the middle scalene posteriorly, and the first rib inferiorly.

Causes of thoracic outlet syndrome

Thoracic outlet syndrome can be congenital or acquired. Specific causes include;

• Cervical rib: it is an extra rib that grows from the cervical spine, the neck part of the spine. 1 and 3 % can have cervical rib, which may grow on one side or both, and may reach down to attach to the first rib or might not be fully formed. Having a cervical rib increases the chance of nerve or blood vessel impingement between the rib or its muscles and ligaments connections sharing this small space. A small percentage of people with a cervical rib develop thoracic outlet syndrome. So many people with a cervical rib are difficult to diagnose, because the bone is tiny in most cases and isn’t noticed, even in X-rays.

• Abnormal muscle or first rib formation: Some people may have an extra or large scalene muscle or an abnormal first rib or collarbone. Any of these abnormal formations can impinge blood vessels, veins, and nerves.

• Whiplash: Arm and hand symptoms that stay long after a whiplash injury can develop symptoms of thoracic outlet syndrome.

• Bodybuilding: Built-up muscles in the neck may cause hypertrophy (large muscles) and impinge nerves or vessels.

• Repeated overhead motions: People who do repeated overhead activities are more prone to have thoracic outlet syndromes such as swimmers, baseball players, painters, hairstylists, and auto mechanics.

• Tumor in the neck: On rare occasions, a tumor might be the cause of the impingement of nerves and arteries.

Types and symptoms of thoracic outlet syndrome

Neurogenic thoracic outlet syndrome occurs when there is an impingement of the nerve. This is the most common form.

Symptoms would be like pain, tingling and numbness in shoulder arm and hand, weakness in the shoulder and arm muscles, change in color and temperature of hand and muscle wasting or atrophy in hand can be seen in case of severe compression of the nerve.

Venous thoracic outlet syndrome occurs when there is an impingement of vein leading to upper body thrombosis. Only 5%of cases are venous.
Symptoms would be like weakness of pulse in arm, pallor or paleness in hand and involved arm, swelling, weakness, and loss of sensation in involved arm.

Arterial thoracic outlet syndrome occurs when an artery has impinged, and sometimes because of the blood clots. It is a rare case.
Symptoms would be like heaviness and sharp shooting pain in the arm, weak pulse in hand, and swelling or redness of arm.
Diagnosis of thoracic outlet syndrome

There are some physical tests that can differentially diagnose thoracic outlet syndrome. These include:-

• Adson’s test
• Roos test
• Wright’s test
• Costoclavicular test.

If this one of these tests provoking symptoms that means you are positive for thoracic outlet syndrome.

Treatment of thoracic outlet syndrome

Physiotherapy plays an important role in the case of acquired thoracic outlet syndrome.
• Stretching exercises to increase flexibility in neck muscles.
• Range of motion exercises for neck, shoulder, elbow, and Hand to increase joint function and to reduce stiffness.
• Strengthening exercises to increase strength in arm and neck muscles.
• Hot pack to reduce spasm in neck muscles.
• Electrotherapy to reduce pain.
• Avoid repetitive overhead activities that will help to reduce symptoms.
Surgery is required for congenital cases such as a cervical rib or other congenital anomalies.

Physio rehab is crucial for a speedy recovery.

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