What Is Thoracic Outlet Syndrome?
Compression, damage, or irritation of nerves or blood vessels (arteries and veins) in the lower neck and upper chest region are used to describe a range of illnesses collectively known as thoracic outlet syndrome (TOS). A cluster of nerves and blood vessels known as thoracic outlet syndrome is present in the region between your lower neck and upper chest (the thoracic outlet).
Symptoms Of Thoracic Outlet Syndrome
Affected parts of the neck, shoulders, and arms may experience discomfort, numbness, or decreased blood flow due to TOS.
Many people confuse the pain of thoracic outlet syndrome with angina (chest discomfort owing to an insufficient supply of oxygen to the heart muscle). However, thoracic outlet syndrome pain does not develop or intensify when walking, but angina pain frequently does. In contrast to angina, the pain from TOS usually worsens as you raise the afflicted arm.
Patients with TOS can be diagnosed based on their symptoms and signs. Depending on where the body is affected, there are several different types of thoracic outlet syndrome problems. The nerves, veins, and arteries can be affected by Thoracic outlet syndrome (the least common type). The thoracic outlet space is reduced in all kinds of TOS, and scar tissue forms around the structures.
Symptoms and Types of thoracic outlet syndrome diseases
The brachial plexus, a network of nerves that supplies the arm and hand with motor (movement) and sensory (feeling) function, can be compressed and irritated by the irregularities of bone and soft tissue in the lower neck region (including the cervical rib area). Hand numbness, tingling, prickling, numbness, and weakness are all possible symptoms of a condition known as axonal neuropathy, characterized by a loss of hand muscle mass on one side of the body.
The main veins in the lower neck and upper chest might be damaged, resulting in venous thoracic outlet syndrome. The onset of the illness is commonly triggered by an unusual and exhausting workout of the arms. Body aches and weakness, especially in the arms and neck, are common symptoms of this condition. It is also possible to see dilated veins in the front (front) chest wall veins (swollen).
Congenital bone anomalies cause TOS in the lower neck, and the upper chest is the rarest but most dangerous condition. Some of the signs and symptoms include numbness, discomfort, or sores in the fingers or hands and a general lack of blood flow to the arms and hands.
Causes Of Thoracic Outlet Syndrome
There is still a great deal of mystery around the illnesses that TOS can bring on. The thoracic outlet's narrow channel produces TOS when blood vessels or nerves inflamed due to aberrant compression. In some cases, the condition known as thoracic outlet syndrome can be caused by an additional first rib (the cervical rib) or an old fracture of the clavicle (the collarbone). One of the numerous potential reasons for TOS is bone or soft tissue anomalies. Thoracic outlet syndrome can be caused by the following:
Sleep apnea and insomnia
Large lymph nodes or tumors in the underarms or upper chest
Anxiety or sadness
Baseball, swimming, golf, and volleyball are a few activities that need a lot of repeated arm and shoulder movement.
Carrying large burdens on one's shoulders might lead to repetitive strain injuries.
Neck and back injuries (whiplash injury)
Negative body language
Weightlifting
Diagnosis From Thoracic Outlet Syndrome
The most critical stage in TOS is to make a correct diagnosis. Vascular surgeons, thoracic surgeons, and doctors in vascular medicine all deal with this issue.
Your doctor will conduct a thorough physical examination and evaluate the findings of any previous diagnostic tests to make a diagnosis.
A complete assessment by a trained neurologist may be necessary to rule out cervical spine disease or other neurological diseases that may be mimicking or causing your symptoms
Thoracic outlet syndrome can also be diagnosed by the use of the following additional tests:
Studies of nerve conduction (to evaluate the function of the motor and sensory nerves)
Studies on the vascular system (of the arteries or veins)
Exam of the chest to rule out any anomalies of the cervical ribs
Examine the cervical spine with X-rays to rule out the presence of an abnormality in the neck or cervical ribs
A chest CT scan or MRI to rule out cervical spine impingement (pressure), which might resemble neurogenic thoracic outlet syndrome, are also recommended.
Imaging of blood vessels using angiography using magnetic resonance imaging (MRI)
Is This Syndrome Serious?
Although many instances of thoracic outlet syndrome (TOS) can't be avoided, the ailment may be successfully treated. There are some possible problems if TOS is left untreated.
A permanent swollen and inflamed arm (especially in patients with venous TOS)
Fibular ischemia-reperfusion injury (open sore caused by reduced blood flow)
Acute necrosis of the tissue (the death of body tissue, often caused by a loss of blood flow)
A clot in the blood
Permanent nerve injury
Prevention From Thoracic Outlet Syndrome
Avoid repeated activities and heavy lifting if you are at risk of thoracic outlet compression. You may avoid or alleviate symptoms of thoracic outlet syndrome by decreasing weight.
Thoracic outlet syndrome sufferers should avoid carrying large bags over their shoulders since this puts additional strain on the thoracic outlet. Stretch your shoulders every day and do exercises to strengthen them.
Thoracic outlet syndrome can be avoided by performing daily stretches that target the chest, neck, and shoulders.
Treatment From Thoracic Outlet Syndrome
Treatment outcomes may be improved by early detection of TOS. The kind of TOS you have and the symptoms you're experiencing influence the therapy options available for your condition. The treatment's main purpose is to alleviate patients' symptoms and discomfort. Your doctor will help you choose the best treatment choice for you.
Talk to your doctor about the possible advantages, risks, and side effects of your treatment choices before making a decision. However, some of the common treatments are,
Neurogenic Thoracic Outlet Syndrome Treatment
Neurogenic thoracic outlet syndrome is often treated with physical therapy as the first line of treatment. Improved posture and increased range of motion are two of the benefits of physical therapy for neck and shoulder pain. Physical therapy has a positive effect on the majority of patients.
Medications: Aspirin, acetaminophen (Tylenol), and ibuprofen (Motrin) are common over-the-counter pain relievers. A muscle relaxant may provide additional pain relief, which your doctor may prescribe.
A Remedy For The Syndrome Of The Venous Thoracic Outflow
For venous thoracic outlet syndrome, thrombolytic or anticoagulant medicines and surgery may be used to prevent blood clots and pulmonary embolisms. Thrombolytic medicines and anticoagulant treatment may be used before surgery in several circumstances.
Drugs that break up blood clots are known as thrombolytics. The patient is given this sort of medicine in the hospital to be properly watched. To administer medicine, either directly into the vein or using a catheter (long thin tube), the catheter is directed through the vein to the location where the blood clot lies. The catheter is used to deliver the clot-dissolving medication. For the most part, the clot disappears within a few days to a few hours. In certain circumstances, angioplasty (opening the vein using a balloon) may be necessary to prevent more clots from developing in the restricted vein. Surgery is typically indicated after a clot in a vein has been successfully treated or eliminated.
To prevent more clots, anticoagulant drugs reduce the blood's capacity to clot. Warfarin (Coumadin), heparin, low-molecular-weight heparin, and fondaparinux are anticoagulant medicines (Arixtra). The anticoagulant medicine recommended to you will be explained to you in detail.
To Treat Arterial Thoracic Outlet Syndrome
Surgical intervention is common in patients with arterial thoracic outlet syndrome. The first rib may be surgically removed to free up more space for the arteries and nerves in the area. Any arterial structural issues may be repaired surgically as well.
If blood clots are a concern, anticoagulant drugs called thrombolytics may be administered before surgery to help dissolve them. The patient is given this sort of medicine in the hospital to be properly watched.
It is possible to administer the drug directly into the artery or by use of a catheter, a long, thin tube that is inserted into the artery and directed to the place where the blood clot is. The catheter is used to deliver the clot-dissolving medication. For the most part, the clot disappears within a few days to a few hours. In certain circumstances, angioplasty (opening the artery using a balloon) may be necessary to prevent more clots from developing in the restricted section of the artery.