Thoracic outlet syndrome
Upper limbs
The cervicothoracic outlet is a triangular space bounded by the posterior edge of the anterior scalene muscle, the anterior edge of the middle scalene muscle, and the upper surface of the first rib.
1) Understanding Thoracic Outlet Syndrome
This space serves as a passageway for several vascular and nerve structures connecting the neck and the arms.
2) What does Thoracic Outlet Syndrome mean?
This condition refers to a group of disorders caused by compression of nerves, arteries, and/or veins passing between the neck and thorax.
- Nerve compression can cause tingling sensations in the hands, upper limbs, or neck
- Artery compression can make the upper limbs pale and cold
- Vein compression can cause swelling and a bluish skin color in the limbs
These compressions usually occur in this small passage between the neck and thorax. The exact causes are sometimes not fully understood, but several factors are suggested:
- An anatomical anomaly (bone or musculo-ligamentous) promoting compression of nerves or vessels
- Postural defects: forward head, drooping shoulders
- Trauma or sudden movement
- Excessive joint pressure, caused by overweight or carrying a heavy backpack
- Pregnancy, which promotes joint laxity
This syndrome is more common in women and typically occurs between 35 and 55 years old.
3) Thoracic Outlet Syndrome: Is it serious?
The severity can vary depending on the structure compressed and the degree of compression. Nevertheless, it is a condition that requires professional follow-up.
Diagnosis is based on the patient’s history and clinical examination, confirmed by medical imaging (X-ray, MRI, angiography, EMG).
It is important to note that symptoms may vary from case to case, sometimes making the diagnosis difficult.
These examinations will determine both the severity and the therapeutic approach, whether surgical or non-surgical.
4) Is surgery an option?
Conservative treatment remains the preferred approach, combining physiotherapy and medical treatment, along with pain relievers.
Surgery may be necessary if an anatomical anomaly or pressure on major blood vessels is confirmed, or if symptoms continue to progress.
The decision to operate will be made after discussion with the orthopedic specialist in charge of your case.
5) Treatment of Thoracic Outlet Syndrome
Conservative and post-operative treatments share many common points.
It starts with immobilization of the shoulder to allow the tendon to heal.
Once healing is respected, the work focuses on:
- Identifying the circumstances causing the problem
- Joint mobility of the neck, shoulder, and thoracic spine
- Muscle strengthening to promote thoracic cage expansion
6) What can I do to speed up the process?
To accelerate healing of thoracic outlet syndrome, follow the recommendations of your healthcare professionals as closely as possible.
Laziness or, conversely, overzealousness, are your enemies.
Discipline, rigor, perseverance, and a positive, determined mindset will help you recover and get back to full strength as quickly as possible!