Thoracic Outlet Syndrome (cont.)

The diagnosis of thoracic outlet syndrome is suggested by the symptoms and supported by findings of the doctor during the examination. Certain maneuvers of the arm and neck can produce symptoms and blood vessel "pinching" causing a loss of pulse. Further supportive testing can include electrical tests, such as electromyogram and somatosensory evoked responses (although these may not be positive in all patients). Some patients can have angiogram x-ray tests that demonstrate the pinched area of the blood vessel involved.

Treatment of the thoracic outlet syndrome can usually be successful with conservative measures. Treatments include a variety of exercises that effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for thoracic outlet syndrome, and their evaluation of the patient can be helpful. Shoulder-shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet.

Patients should avoid prolonged positions with their arms held out or overhead. For example, it is best to avoid sleeping with the arm extended up behind the head. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on their stomach with their arms above the head. They should also not repetitively lift heavy objects.

Some patients with severe, resistant symptoms can require surgical operations to open the thoracic outlet. These procedures include removal (resection) of the first rib in order to spare injury to the affected nerve and blood vessels from ongoing compression.

• Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit.
• Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration).
• Diagnosis of thoracic outlet syndrome is suggested by the symptoms and physical findings and is sometimes supported by electrical and/or radiology tests.
• Treatment of thoracic outlet syndrome usually involves physical-therapy exercises and avoiding certain prolonged positions of the shoulder.

References:

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.

Last Editorial Review: 2/20/2008

Source: MedicineNet.com
http://www.medicinenet.com/thoracic_outlet_syndrome/article.htm