Thoracic Outlet Syndrome


Disease of compression of the muscles and nerves coming out of the chest: Thoracic Outlet Syndrome

The nerve bundles formed by the nerves spreading towards the arm, arteries and veins under the collarbone may encounter compression in the groove where they exit the chest cage for various reasons. A condition called “Thoracic outlet syndrome” may sometimes occur as a result of the development of a fibrous band in the area formed by the collarbone, the lateral protrusion of the 7th cervical vertebra, the 1st rib, and a muscle called scalenus anticus. Neck and arm pain, numbness in the arm, and movement disorders are the most common findings. More rarely, premature fatigue, coldness and numbness in the arms may occur as a result of the artery in the region being compressed between the structures listed above. If the vein is under pressure, this time, pain, swelling in the arm and discoloration in the form of bruising may occur. Fatigue in the arms is especially evident when working above, and the patient cannot perform such work at all.

Scalenus anticus syndrome:

The disease may occur due to negative stretching or enlargement of these muscles in situations such as posture disorders, professional mistakes, emotional stresses, and compression of the vascular-nerve bundle. The pain is dull and its exact location cannot be described. It may wake the patient up at night or in the morning. It is seen to occur in middle-aged women who sit for long periods of time and do jobs such as sewing and knitting.

Cervical Rib:

The lateral protrusion of the 7th vertebra is longer than normal and the presence of a fibrous compressive band between it and the 1st rib bone may initiate the disease. Exercises, physical therapy and some medications are the treatment options. These are anti-inflammatory and muscle relaxant drugs.

Costoclavicular syndrome:

It is a disease that occurs due to the compression of the vascular and nerve bundle between the 1st rib and the collarbone. Fatigue caused by excessive use of the arms, some traumas and postural disorders may also cause this condition. Pain may increase with a sharp pulling of the shoulders back and downwards (exaggerated military posture). Having this situation checked by a doctor may also trigger the pain. Treatment, exercise and physical therapy are recommended for the cause.

Pectoralis minor syndrome:

It occurs as a result of compression of the vascular nerve package between the shoulder blade and the 3rd, 4th and 5th ribs. It is usually seen in people who sleep with their arms raised above their heads at night. In the test that reveals the disease, it is seen that the pain increases when the arm is opened to the side, lifted from the side over the head and pulled back. Undoubtedly, sleeping style should be changed, posture should be corrected, exercise and necessary physical therapy methods should be used.

Diagnostic Methods in Thoracic Outlet Disease

In this disease, the probability of nerve compression is 90%, while the probability of vessel compression is 10%. Therefore, when the search for a diagnosis, which begins with nerve examinations, is inconclusive, evaluations regarding the veins can be used. In cases where TOS of vascular origin is suspected, this simple vascular test can make important contributions when deciding on detailed vascular examinations. While the shoulders and elbows are bent at 90 degrees, they are asked to open and close their hands non-stop for 3 minutes. We can say that those who have to abandon this test due to early fatigue and loss of strength in the muscles as a result of reduced blood flow to the arms due to compression of the vessels have TOS, which has a vascular problem. For further examination, radiological examinations of the arteries and veins are planned. The presence of the band causing congestion can be demonstrated with computed tomography. Magnetic resonance (MRI) can help diagnosis by showing soft tissues better. In cases where numbness prevails in the arms, EMG (electromyography) examination, called electromyography of the muscles and nerves, should be performed.

Treatment of Thoracic Outlet Syndrome

It is essential to stay away from professional work that presses the shoulders down or, on the contrary, keeps them constantly up. If the reason that causes wrong posture in the body is weight, it should be reduced. Likewise, if large or sagging breasts are determined to be the cause of TOS, reinforced bras are recommended and even a plastic surgery may be recommended. To correct posture, gradually increasing intensity of exercise programs for the shoulder junction and neck, physical therapy applications and, in some cases, local injections may be recommended.

Hot springs, sun and especially swimming can lead to positive results in TOS cases. Surgery is the least commonly used method and its applicability is gradually decreasing. Fibromyalgia has an important place among the causes of neck pain. Fibromyalgia is very easily overlooked because other symptoms besides pain are not questioned by physicians. Although they talk about pain from head to toe, there are many patients who are diagnosed with cervical disc herniation and undergo surgery because of their neck pain, which sometimes comes to the fore.