Thoracic Outlet Syndrome happens when the nerves or blood vessels that are between the clavicle and the first rib become compressed, causing pain in the shoulder or tingling in the arms and hands, for example.
Normally, this syndrome is more frequent in women, especially those who have had a car accident or repetitive injuries to the chest, but it can also develop in pregnant women, reducing or disappearing after childbirth.
Thoracic outlet syndrome is curable through surgery, however, there are other treatments that help control symptoms, such as physical therapy and strategies to decrease the compression of the site.
Compression of nerves and blood vessels
Symptoms of Thoracic Outlet Syndrome
Symptoms of this syndrome can be:
- Pain in the arm, shoulder and neck;
- Tingling or burning in the arm, hand and fingers;
- Difficulty moving your arms, due to weakness and loss of muscle mass;
- Due to poor blood circulation, symptoms such as purple or pale hands and fingers may appear, fatigue, altered sensitivity, decreased temperature in the area;
- Pain in the side of the head and neck, region of the rhomboid and suprascapular muscle, lateral of the arm and above the hand, between the index and the thumb, when there is compression of C5, C6 and C7;
- Pain in the suprascapular region, neck, medial part of the arm, between the ring and pinky fingers, when there is compression of C8 and T1;
- When there is a cervical rib, there may be pain in the supraclavicular region that worsens when opening the arm or holding heavy objects;
- When there is compression of the veins, symptoms such as heaviness, pain, increased skin temperature, redness and swelling may occur, especially in the shoulder.
breastplate
When presenting these symptoms, it is important to consult an orthopedist or physiotherapist to make the correct diagnosis with the provocation tests of the symptoms, the diagnosis is made by observing the symptoms, not being mandatory to perform tests, but the simple X-ray and 2 positions of the cervical spine, chest and trunk, can be useful to check the narrowing of the region.
Symptoms of thoracic outlet syndrome
Symptom provocation tests can be:
- Adson test: The person should take a deep breath, turn the neck back and turn the face to the examined side. If the pulse decreases or disappears, the signal is positive.
- 3-minute test: open the arms in external rotation with 90 degree flexion of the elbows. The patient should be opening and closing the hands for three minutes. The reproduction of symptoms, numbness, paresthesia and even inability to continue the test are positive responses. Normal individuals may experience limb fatigue, but rarely paresthesia or pain.
Other tests that can be ordered by the doctor include computed tomography, magnetic resonance imaging, myelography, magnetic resonance imaging and Doppler ultrasound that can be ordered when other diseases are suspected.
Treatment for Thoracic Outlet Syndrome
Treatment should be guided by an orthopedist and usually starts with taking anti-inflammatories, such as Ibuprofen and Diclofenac, or pain relievers, such as Paracetamol, to relieve symptoms in times of crisis. In addition, it is recommended to do physical therapy to strengthen the muscles and improve posture, preventing the onset of these symptoms.
The use of warm compresses and rest can be useful for the relief of discomfort, but in addition, if you are overweight you should lose weight, avoid raising your arms above the shoulder line, carrying heavy objects and bags on your shoulders. Neural mobilization and pompage are manual techniques that can be performed by the physiotherapist, and stretching exercises are also indicated.
Thoracic Outlet Syndrome Exercises
Exercise helps to decompress nerves and blood vessels near the neck, improving blood flow and relieving symptoms. It is recommended to consult a physiotherapist before doing the exercises, adapting them to each case.
Exercise 1
Tilt your neck to the side as far as possible and stay in this position for 30 seconds. Then do the same exercise for the other side and repeat 3 times.
Exercise 2
Stand up, put your chest out and then pull your elbows back as far as possible. Stay in this position for 30 seconds and repeat the exercise 3 times.
In the most severe cases, in which the symptoms do not disappear with the use of drugs or physical therapy, the doctor may advise vascular surgery to decompress the affected vessels and nerves. In surgery, you can cut the scalene muscle, remove the cervical rib, remove the structures that may be compressing the nerve or blood vessel, and which is responsible for the symptoms.
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