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The Thoracic Outlet Syndrome #2 - Signs and Symptoms

Updated on September 26, 2014

Introduction

Usually the signs and symptoms of Thoracic Outlet Syndrome mimic those of Cervical Discogenic Syndromes. Hence a thorough and judicious examination and evaluation is resorted to before proceeding with the treatment.

Investigations

Investigations include certain tests to look for the real underlying pathology. These investigations are also intended to exclude other conditions that may initiate almost similar signs and symptoms as those of Thoracic Outlet Syndrome.

  1. Blood Tests- to rule out certain rheumatic conditions
  2. X ray- It may show Cervical Rib or Fibrous Band, if present and Elevated First Rib caused by tight Anterior or Middle Scalene Muscles. It also shows Displaced Fracture Clavicle, Non Union and Mal Union of Clavicle, Excessive Callous Formation, Cervical Spine Degenerative changes e. t. c.
  3. MRI or/and CT Scan- of the Cervical Spine, Supraclavicular and Brachial Plexus areas, Apex of the Lungs e. t. c. to exclude other similar conditions. Also to exclude Malignant Lesions in the chest.
  4. Nerve Condition Studies- to find out if any nerve is involved and to find out which nerve is involved.
  5. Doppler and Plethysmography- to study whether there is any impediment of blood flow in the blood vessels.
  6. Angiography-to find out whether there is any block from thrombi or emboli in the Subclavian Artery. It also helps to find out whether there is any aneurysm in the artery that may compress the Brachial Plexus.
  7. Venography- to find out whether there is any block from thrombi or emboli in the Subclavian Vein.

Signs and Symptoms

Symptoms will depend on the type of Thoracic Outlet Syndrome. In other words, the symptoms depend on what anatomical structures are being squashed or compressed when they emerge through the Thoracic Outlet. In most of the cases it is the Brachial Plexus that is getting compressed rather than the Subclavian Vessels. It is estimated that more than 90%of all Thoracic Outlet Syndromes are neurogenic as the Syndrome is due to the involvement of Brachial Plexus. It is also estimated that only 3-5% of all Thoracic Outlet Syndromes are Venous and less than 1% are Arterial. At times there may be compression of both the Brachial Plexus as well as the Subclavian Blood Vessels. In such cases you will get a combination of signs and symptoms. The signs and symptoms may be unilateral or bilateral.

Signs and Symptoms –Neurogenic Type (90%)

  1. Women are most commonly affected.
  2. Usually feels pain or/and a feeling of ‘pins and needles’. Usually felt along the inner side of the arm (along the medial side of the forearm) and end up in the ring and little finger. Pain may be felt at the neck, ear, upper back, upper chest and outer arm depending on the involvement of particular nerves.
  3. Pain and the feeling of ‘pins and needles’ may be worse at night and it may give a disturbed sleep.
  4. Wasting and weakness of the small muscles of the hand on the involved side, with or without pain.
  5. Numbness may be present on various dermatomes depending on which nerve is involved.
  6. Symptoms may be vague and general.
  7. The symptoms may be unilateral or bilateral.

Signs and Symptoms-Venous Type (3-5%)

  1. Young men are most commonly affected.
  2. Swelling in the involved upper limb
  3. Pain and a feeling of ‘pins and needles’ in the involved upper limb.
  4. Distention of the Vein.
  5. Diffuse pain in the involved upper limb.
  6. Upper limb may present with bluish colour.
  7. The symptoms may be felt intermittently.
  8. The symptoms may become worse on excessive use of upper limb.
  9. If a blood clot in the Subclavian Vein result in blockage of the Vein the symptoms may remain constant. In such cases urgent medical intervention is essential.
  10. The symptoms may be unilateral or bilateral.
  11. Sweating or perspiration may be present.

Signs and Symptoms-Arterial Type (less than 1%)

  1. Men and women are equally affected.
  2. Pain and a feeling of ‘pins and needles’ in the involved upper limb. Hence there is compression of Subclavian Artery, the arterial blood supply to the involved upper limb is diminished.
  3. Upper limb may present with colour changes and may become pale.
  4. Upper limb may feel cold.
  5. The symptoms may be felt intermittently.
  6. The symptoms may become worse on excessive use of the upper limb. The patient usually ignores the early symptoms and he may resort to medical intervention only when the condition gets deteriorated. Pure type of Thoracic Outlet Syndrome is very rare and hence it is usually presented with a mixture of symptoms, indicating the involvement of more than one cause.
  7. The symptoms are unilateral or bilateral.
  8. Sweating or perspiration may be present.

Signs and Symptoms –Other Types

  1. Men and women are almost equally affected, incidence rate slightly more in women.
  2. Pain and a feeling of ‘pins and needles’ in the involved upper limb, usually in the dermatomal distribution.
  3. Sensory impairment – Numbness may be present on various dermatomes depending on which nerve is involved. That is, paraesthesia on dermatomal distribution.
  4. Weakness of the muscles in the cervical region, shoulder girdles, shoulders and the small muscles of the hand.
  5. Wasting of the muscles in the cervical region, shoulder girdles, shoulders and the small muscles of the hand.
  6. Usually found in young, middle aged, healthy and active adults.
  7. Symptoms usually get worsened on excessive use of upper limbs.
  8. The symptoms may be unilateral or bilateral.
  9. Forward head Posture’ usually present with the head protruded forward, the shoulders drooped and the scapulae tilted and rotated forward and downward.

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