Thoracic Outlet Syndrome

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Definition:

Symptom complex characterized by pain, parasthesia, weakness and discomfort in the upper limb which is aggravated by elevation of the arms or exaggerated movements of the head and neck’ (Lindegren and Oksala 1995)

‘Upper extremity symptoms due to compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle’ (Saunders, Hammond, Rao 2007)

Classification of compression:


Incidence:

Affects 8% of the population
Females are more commonly affected than males (between 4:1 and 2:1)
Predominantly occurs between the ages of 20 and 40
Rare in children and but when it does occur it presents most commonly as vascular Thoracic outlet syndrome
Neurological is more common than vascular Thoracic outlet syndrome: (98% and 2% respectively)

How does it occur:

Trauma
Brought on by a change in activity
Repetitive activity or sustained postures
Weight gain or increased muscle bulk
Arterial Thoracic outlet syndrome usually develops spontaneously

Pattern of symptoms:


Vague
Ill defined
Diffuse
Involving the entire upper extremity
Maybe constant or intermittent due to duration or severity
Can involve descriptions of pain, altered sensation and weakness
May have sympathetic symptoms

What else could it be if it isn't Thoracic outlet syndrome?

Cervical pathology
Brachial plexus injury (blow or traction injuries)
Chronic regional pain syndrome
Apical lung tumour
Carpal tunnel syndrome
Raynaulds

So if in doubt see you Physiotherapist!

Diagnostic tests:

Adsons Maneuver:

Costoclavicular Maneuver::

Wrights test/hyperabduction maneuver::

Roos stress test/ Elevated arm stress test – EAST:

Management:

Surgery/conservative treatment is controversial
Conservative treatment is trialed first
Referred if symptoms do not respond to conservative treatment in 6 weeks
Patients with severe symptoms such as vein engorgement, swelling or progressive muscle wasting should be referred on for further investigation immediately
True Thoracic outlet syndrome is more likely to require surgery than symptomatic Thoracic outlet syndrome.

What does Physiotherapy target?

Patient education
Postural re-education
Orthosis
Weight loss
Trigger point
Myofascial release
Stretching
Muscle imbalance work for shoulder girdle and neck – predominantly scapula recruitment and control

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

WWW.HAWKESPHYSIOTHERAPY.CO.UK


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