Related articles: Thoracic outlet syndrome
Definition
Thoracic outlet syndrome is a set of clinical manifestations united by phenomena of irritation, traction and compression of the vascular and nerve structures, which run from the cervical region to the axilla.
The predisposition to conflictuality of the vasculostatic bundle can be constitutional, postural or traumatic. A particular physical conformation, for example, can lead to the stretching of the nerve bundles of the thoracic strait, as well as an excessive development of the muscular masses of the upper limbs can reduce the space at the pectoral level. Furthermore, work activities that require prolonged use of the hands with suspension of the upper limbs are responsible for intermittent repetitive compressive phenomena. Among the factors triggering the thoracic outlet syndrome there is often a previous cervical distortion (whiplash) trauma, responsible for contracture phenomena and consequent repair in fibrosis.
The thoracic outlet syndrome can also be caused by the anomalous insertion of the scalene muscles, by the presence of a supernumerary rib from the cervical spine or by a badly welded fracture of the clavicle. The disorder is more common among women and generally appears between 35 and 55 years of age.
Most common symptoms and signs *
- Swollen arms
- Cyanosis
- Neck pain
- Hand and wrist pain
- Shoulder pain
- Arm pain
- Tingling in the right arm
- Tingling in the Left Arm
- Tingling in the right hand
- Tingling in the hands
- Heat intolerance
- Hypoaesthesia
- Microcephaly
- Paresthesia
- Stiffness in the muscles of the back and neck
Further indications
The symptoms of thoracic outlet syndrome primarily affect the upper limb. In particular, pain and tingling appear at the level of the hand, neck, shoulder or arm. There may also be a sense of weakness and easy exhaustion, especially if the posture includes the upper limbs in elevation and far from the trunk. Less frequently, there are vascular signs such as swelling, cyanosis and highlighting of the superficial venous circulation.
Thoracic outlet syndrome can involve muscular hypotrophy, moderate sensitivity changes and, rarely, vascular complications (Raynaud's syndrome, arterial pulse loss, cold limb and distal gangrene).
Diagnosis is suggested by the distribution of symptoms. The echocolordoppler of the upper limb vessels can confirm the presence of a narrowing of the vascular structures present in the thoracic outlet.
Chest radiography and load angiography can support diagnosis.
The therapy generally includes rehabilitative exercises (manual lymph drainage, kinesitherapy and gradual postural re-education) and the administration of tricyclic analgesics and antidepressants at low doses.
In the most serious cases, which do not respond to the conservative approach and show significant or progressive neuro-vascular deficits, surgical treatment may be indicated, variable in relation to the type of anatomical factor in question.
