Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome is a term used for several different conditions that can occur when nerves and blood vessels in the thoracic outlet are compressed or irritated. The thoracic outlet is the narrow space between your collarbone and first rib. Blood vessels, nerves, and muscles that extend from the back to the arms pass through this area. If the space in the thoracic outlet is too narrow, these structures can become compressed. The increased pressure on the blood vessels and nerves may cause pain in your shoulders, neck, and arms. It can also cause numbness or tingling in your hands.
Types of Thoracic Outlet Syndrome
Vascular – Compression of the artery and/or vein. This type of thoracic outlet syndrome occurs when one or more of the veins or arteries under the collarbone (clavicle) are compressed. Vascular thoracic outlet syndrome symptoms include: discoloration of your hand, arm pain and swelling, blood clot in veins or arteries in the upper area of your body, lack of colour in one or more of your fingers or your entire hand, weak or no pulse in the affected arm, cold fingers, hands or arms, arm fatigue with activity, numbness or tingling in your fingers, weakness of arm or neck or a throbbing lump near your collarbone.
Neurogenic – The nerves become compromised from an extra cervical rib (see Figure 1 below), present at birth. This form of thoracic outlet syndrome is characterised by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic. These neurogenic symptoms include; muscle wasting in the fleshy base of your thumb, tingling sensation in your arm or fingers, pain or aches in your neck, shoulder or hand and lastly weakening grip.
Nonspecific-type (Disputed or painful form) – No neurological deficit but patients experience neurological symptoms and pain. Typically, these patients’ clinical tests are negative, but they complain of pain. This type is also called disputed TOS. Doctors find the reality of nonspecific TOS debatable. People with nonspecific-type thoracic outlet syndrome have chronic pain in the thoracic outlet that worsens with activity, but a specific cause of the pain can’t be determined.
How is Thoracic Outlet Syndrome Diagnosed?
Your doctor will perform a physical exam and review your symptoms. The doctor might perform a few tests to reproduce the symptoms to make a more accurate diagnosis. The doctor might also send you to do an X-ray, MRI, Electromyography (EMG), or a nerve conduction study to confirm your diagnosis.
How can a Biokineticist help you?
Biokinetic treatment is recommended to help strengthen and stretch the shoulder muscles. Your Biokineticist can help you to strengthen these muscles to improve your range of motion and your posture. Exercises can provide support for the collarbone and the muscles surrounding the thoracic outlet. Regular exercises may take the pressure of the blood vessels and nerves affected in the thoracic outlet area.
If you are overweight your Biokineticist can assist you with a weight-loss training program focusing on exercises that will help relieve symptoms over time. A healthy weight is important for reducing pressure on the joints affected.
Prevention is better than cure therefore your Biokineticist will educate you on the following;
- How to maintain a proper posture while sitting or standing
- How to perform the correct stretches
- Guidance on maintaining a healthy weight and lifestyle
- Performing strengthening exercises
- How to avoid activities that make your symptoms worse
- How to avoid repetitive movements
- The correct way to lift heavy objects
What is Thoracic Outlet Syndrome?
More on Thoracic Outlet Syndrome
Mayo Clinic’s take on Thoracic Outlet Syndrome
Thoracic Outlet Syndrome from Orthopaedic Surgeons perspective