THORACIC OUTLET SYNDROME

TYPES

The three types of thoracic outlet obstruction include:

• Neurogenic- This results from the impingement of the network of nerves that is commonly termed as brachial plexus. This network of nerves is responsible for regulating the movement and sensation of the upper extremities.
• Non-specific thoracic outlet syndrome- Patients exhibit phantom pain. They are aware of the discomfort in the area where the thoracic outlet is located, but the thorough investigation could not pinpoint the exact cause or origin of the pain.
• Thoracic syndrome secondary to a vascular cause- There is the pressure exerted in the venous structures (those responsible for circulating blood to the body) located beneath the clavicle

SYMPTOMS

Signs and symptoms of thoracic outlet may vary in intensity and show any of the following:

• Loss of muscle bulk most prominently seen in the origin of the thumb
• Tingling sensation in the arm or fingers
• Nape pain
• Loss of tight grip
• Cyanosis of the affected limb (due to the cut off of blood supply from the thorax)
• Presence of clogged veins or arteries in the upper extremity (arm and forearm)
• “Cold to touch” affected extremity
• No palpable pulse on the affected extremity
• Pins and needles sensation on the fingers
• A feeling of tiredness with minimal activity noted on the affected side
• Palpable, pulsating mass noted on the clavicle

DIAGNOSIS

Your clinician, upon arrival, will ask for your history and do a complete physical examination. After which, he/she may do any of the following tests:

• Radiographic imaging- Visualization of the affected area using a radiograph can provide an insight to the clinician as to the cause of thoracic outlet obstruction
• Ultrasonography- Utilization of small frequency waves to visualize the thoracic area for any blocks or clots that can cause vascular occlusion
• Computerized Tomography scan- Visualizes the part of the body in several cross-sections to provide a better view of the structure in question
• Magnetic Resonance Imaging (MRI)- Utilization of magnetic radio waves to visualize the area of the body
• Angiography- Involved the use of a dye injected intravenously to make sure the structural integrity of the blood vessel
• Arteriography and Venography- Utilizes catheterization technique (insertion of a small tube into the femoral area to examine both the artery and the vein)
• Electromyography- tests the electrical integrity of the muscle involved (usually employed if the muscle group in question went into atrophy)
• Nerve conduction study- Uses low electrical current to test the ability of the nerve to receive and convey impulses through their network.

TREATMENT

The following are the treatment approach:

• Rehabilitation of the affected muscle group
• Use of analgesics
• Anti-platelet medications- indicated for cases where a blood clot is found on any of the above mentioned diagnostic parameters.