Thoracic outlet syndrome

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Thoracic outlet syndrome involves compression of the nerves and/or blood vessels that travel from the neck up to the armpit. The compression of these structures can trigger pain, tingling, weakness and numbness from the neck up to the arm.

It is important to note that the thoracic outlet is the space amidst the clavicle and first rib. There are several blood vessels and nerves that travel through this area including the brachial plexus and subclavian vein and artery.

Thoracic outlet syndrome
Shoulder or neck pain is one of the indications of thoracic outlet syndrome.

In case the posture in the shoulder area is not correct, the shoulder drives forwards which drops the collarbone. This leads to the crushing of the blood vessels and nerves beneath it. In the same way, tension in the scalene muscles causes compression.

Congenital structural differences put one at higher risk for develop thoracic outlet syndrome such as collarbone and cervical rib anomalies. Additionally, traumatic injuries involving the clavicle such as a fractured collarbone might also reduce the available space, particularly if malnutrition is present.

What are the indications?

The indications tend to vary based on the exact site and structures that are compressed as well as the extent of compression, but might include the following:

  • Shoulder or neck pain
  • Numbness or tingling in the arm
  • Arm might feel weak or quickly fatigued
  • Cold hand
  • Symptoms aggravated when overhead movements are performed

Management

The treatment is ideally aimed on correcting the root of the compression. In most cases, poor posture is the culprit. The following are the commonly used measures:

  • Stretching of the chest muscles – the pectoralis minor and scalene are the focus of the stretching exercise which is useful in improving the posture of the upper back and shoulder girdle.
  • Sports massage specifically trigger point therapy. The trigger points are the tight localized lumps or knots in the muscles that cause back pain. The treatment is frequently a component of deep tissue massage and includes the application of continuous pressure to the point in the muscle. Once the pain settles, the pressure is increased again. This is repeated 2 or 3 times as needed.
  • Strengthening exercises for the lower trapezius and serratus anterior muscle as well as mobilization of the scapula.

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