Thoracic Outlet Syndrome

-

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


Comments

Post a Comment

Popular posts from this blog

Patella Tendinopathy

-
Image
I hear different terminology used all the time, so what is tendinitis, tendinosis or tendinopathy? Tendinopathy: This is a broad term encompassing painful conditions occurring in and around tendons, which includes tendinitis and tendinosis. Tendinitis: This basically means inflammation of a tendon. Tendinosis:  This means degeneration of tendon (Meaning cumulative damage). So what does this mean to me? For a long time tendinitis was the term used and it was considered that injured tendons were simply inflamed. Then the thinking shifted to the thought that there was little or no inflammation present in these conditions (Andres & Murrell 2008). However as is with research, the thinking is changing again: There may be an inflammatory response associated with chronic tendinopathy, even though recent opinions had decided it to be non-inflammatory (Rees 2013). So both types can occur! This is important as the way that you treat each one has to...
Read more

Cubital Tunnel Syndrome

-
Image
Heard of Cubital Tunnel Syndrome? Probably not but you may have heard of Carpal Tunnel Syndrome. Well they are similar but Carpal Tunnel Syndrome is in the wrist and hand whereas Cubital Tunnel Syndrome is in the Elbow. What is Cubital Tunnel Syndrome? Basically it is a compression neuropathy, which means that a nerve is "trapped”. The nerve at fault in this case is the ulna nerve and where it gets “trapped” is in the cubital tunnel of the elbow: See the below picture: How common is it? It is the second most common compression neuropathy in the upper limb (Palmer & Hughes 2009). What causes it? A common cause is frequent bending of the elbow or constant repetitive pressure on the elbow itself. This then irritates the nerve and it is irritated too much then it becomes a “neuropathy”. What are the symptoms? The patient will complain of pain and numbness in the ring and little finger and weakness is common. If left untreated then this ...
Read more

The case of the clicky hip (AKA: Snapping hip syndrome)

-
Image
Ever wondered what the click in your hip is? Firstly you need to know a little about the anatomy of the area. Bones: Ilium, Ischium, Pubis, Femur: Ilium: Acetabulum (lunate surface, margin of acetabulum) Anterior inferior iliac spine Anterior superior iliac spine Ala (wing of ilium) (gluteal surface and iliac fossa)) Iliac crest (outer lip, tuberculum, intermediate zone, inner lip) Gluteal lines (anterior, inferior and posterior) Posterior superior iliac spine Posterior inferior iliac spine Greater sciatic notch Body of Ilium Illiopubic eminence Arcuate line Auricular surface for the sacrum Iliac tuberosity Ischium: Ischial spine Lesser sciatic notch Body of Ischium Ischial tuberosity Ramus of ischium Obturator foramen Acetabulum Acetabular notch Pubis: Superior pubic ramus Pubic tubercle Obturator crest Inferior pubic ramus Acetabulum Pecten pubis (pectineal line) Symphyseal surface Obt...
Read more