Thoracic Outlet Syndrome | Read Causes, Symptoms, Diagnosis and Treatment

Thoracic outlet syndrome comprises conditions characterized by compression of the neurovascular bundle in it course in the neck and thorax by both muscular and skeletal structures.

Causes of Thoracic Outlet Syndrome

• Skeletal causes
  • Cervical ribs, proximity of the clavicle to the 1^st rib and enlarged 7^th cervical transverse process are the causative factors.

• Muscular causes
  • Hypertrophied scalenus medius muscle or anterior muscles, abnormal insertion of pectoralis minor muscle in chest and fibrous band.

Symptoms of Thoracic Outlet Syndrome

Symptoms are brought on by a particular position of the arm, resulting in compression of the neurovascular bundle, particularly when the affected arm is abducted to 90 degree and externally rotated.

The symptoms may be neurological, vascular or both which can be its causative factor.

• Neurological symptoms
  • These include shoulder and ram pain, referred to the ulnar border or the inner side of the hand and distal half of the forearm and often it is associated with numbness, tingling or paraesthesia (an abnormal sensation).
  • The pain is better on raising the hand above the head.

• Vascular symptoms
  • These are due to compression of the subclavian artery. The above compression produces claudications (lameness), attacks of blanching and cyanosis.
  • Examination is normal unless provocative maneuvers are done like extension of the neck and rotation of the head to the side of the symptoms and posterior rotation of the shoulder.
  • These may produce subclavian bruits (a sound or murmur heard on auscultation) and loss of pulses in the arms.

Thoracic Outlet Syndrome Diagnosis

• Chest X-ray- it will help in indicating presence of cervical ribs.
• The electro-myogram will be abnormal if the brachial plexus is involved.
• Other conditions like cervical disc prolapse, carpal tunnel syndrome, degenerative joint disease and vaso-spastic disorders must be ruled out.

Thoracic Outlet Syndrome Treatment

Only surgical treatment like removal of the cervical or 1^st rib, division of the fibrous band and resection of the scalenus medius muscle gives permanent relief from a structural abnormality.

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