Thoracic Outlet Syndrome.doc

8/10/2019 Thoracic Outlet Syndrome.doc

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Thoracic Outlet Syndrome / Cervical Rib

About 1 in 200 people are born with an extra rib called a cervical rib. About 1 in 10 people who have a cervical rib develop thoracic outlet syndrome. Your thoracic outlet is a

space, or passageway, that lies just above your first rib and behind your clavicle your collarbone!. "t runs from the base of your nec# to your armpit. Your brachial plexus agroup of nerves that pass from your nec# to your arm! and your subclavian artery andvein pass through your thoracic outlet. $horacic outlet syndrome can occur when one or more of these structures is compressed s%uashed! in your thoracic outlet. A cervical ribcan sometimes cause this compression. &ompression of your brachial plexus nerves ismost common. $his can cause pain and pins and needles in your arm on the affected side.
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$reatment can include pain#illers, physiotherapy and sometimes surgery to relieve thecompression caused by, for example, a cervical rib.

Understanding your ribs and your ribcage

Your ribs are curved bones that help to protect your heart and lungs. You have twelve pairs of ribs altogether. $ogether, these twelve pairs of ribs form your ribcage.

At the bac#, the head of each rib articulates ma#es contact with! one of your thoracicvertebrae. Your vertebrae are your bac# bones. Your thoracic vertebrae are your vertebraein your thorax chest area!. You have twelve thoracic vertebrae. Your cervical vertebraeare your vertebrae in your nec#. You have seven cervical vertebrae.

'or your first seven pairs of ribs, at the front, the other end of each rib is attached to somecartilage called costal cartilage. &artilage is a type of special connective tissue.! Your costal cartilage connects each rib to your sternum your breastbone!. Your next three pairsof ribs are joined by their costal cartilage to the rib above them. Your last two pairs of ribsare often called floating ribs because they are just joined to your vertebrae at the bac# anddon(t have a connection at the front.

What is a cervical rib?

About 1 in 200 people are born with an extra rib called a cervical rib. )ecause this issomething that you are born with, it is #nown as a congenital condition. At the bac#, thisrib connects to your seventh cervical vertebra in your nec#. At the front, in some people acervical rib can be (floating( and have no connection. "n other people it can be connected

to your first rib by a band of tough, fibrous tissue. "n some others there may be anarticulation li#e in a joint! with their first rib.

A cervical rib can be present just on your right side, just on your left side, or on bothsides.

What is your thoracic outlet?

Your thoracic outlet is a space, or passageway, that lies just above your first rib and behind your clavicle your collarbone!. $here are also some muscles that surround thethoracic outlet. $he thoracic outlet runs from the base of your nec# to your armpit. Youhave a thoracic outlet on the left and the right side of your body. A number of structures

pass through your thoracic outlet, including some important blood vessels and nerves.$he brachial plexus, a group of nerves that pass from your nec# to your arm, passesthrough your thoracic outlet. $he subclavian artery and subclavian vein are blood vesselsthat pass through your thoracic outlet as they connect between your chest and your arm.


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What is thoracic outlet syndrome and what causes it?

"f you have thoracic outlet syndrome, the nerves and*or blood vessels in your thoracicoutlet are compressed or s%uashed for some reason. "n most cases, it is nerves that arecompressed. $his compression causes the typical symptoms see below!. "n some people,the subclavian artery or subclavian vein may be compressed. +ometimes, a combinationof both nerves and blood vessels may be compressed. $horacic outlet syndrome usuallyonly affects one side of your body. owever, rarely, compression can occur in thethoracic outlet on both sides and so symptoms then occur on both sides. $here are anumber of different things that can cause compression of the nerves or blood vessels inthoracic outlet syndrome.

Having a cervical rib

About 1 in 10 people who have a cervical rib develop thoracic outlet syndrome. +o, most people with a cervical rib do not develop any symptoms. aving a cervical rib can causenarrowing of your thoracic outlet, ma#ing compression of the structures that pass throughit more li#ely.

Other congenital causes

+ome people are born with an extra band of tissue underneath their s#in around thethoracic outlet area called a fibrous band. $his can act a bit li#e an extra rib and causecompression of the thoracic outlet in some people. Anomalous or extra! muscles aroundthe thoracic outlet that you may be born with can also cause narrowing and compression.Also, some people are born with an enlarged or elongated part of a vertebra in their nec# which can cause compression in their thoracic outlet.

A recent accident

"t is %uite common for people with thoracic outlet syndrome to have a history of some#ind of recent trauma to their nec#. 'or example, whiplash following a car accident.$rauma during an accident can cause structures in your nec# and chest wall to moveslightly and narrow your thoracic outlet. "f you fracture brea#! your clavicle

collarbone!, bro#en bone fragments or bleeding due to the fracture can also causenarrowing of the thoracic outlet.

A ob that involves re!etitive movements$horacic outlet syndrome can be more common in someone who has a job that involvesvery repetitive movements or a lot of overhead wor#. $hese movements can lead to (wear and tear( of the nerves of their brachial plexus. Also, people who play a lot of sport,

particularly sports that involve lots of arm movement are also more li#ely to developthoracic outlet syndrome. 'or example, swimmers, javelin throwers and shot putters.


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"oor !osture

-eople with a poor posture and (droopy( shoulders may be more li#ely to develop thoracicoutlet syndrome. +itting in front of a computer for long hours with a poor posture, anincorrect des# position, and an inade%uate chair may be a cause. $his poor posture can

cause narrowing of your thoracic outlet. Also, thoracic outlet syndrome can be a problemfor women who have large breasts. $heir breasts pull the muscles of their chest wallforwards and can cause narrowing of their thoracic outlet and lead to the typicalsymptoms.

Artery and vein !roblems

arrowing and bloc#age of your subclavian artery or vein is another cause of thoracicoutlet syndrome. +ome people can have a congenital narrowing of one of these bloodvessels. "n these people, a blood clot can form if there is a period where the arm isoverused. 'or example, weight lifting or wor#ing for long periods with your arms raised

above your head. "n other people, the blood vessel narrowing may be caused by, for example, a cervical rib. )ecause of this narrowing, a blood clot is more li#ely to form inthe subclavian artery or vein, which can lead to the typical symptoms of blood vesselcompression see below!.

Who gets thoracic outlet syndrome?

/verall, thoracic outlet syndrome is more common in women than men. "t usually affects people between the ages of 20 to 0 years. As mentioned above, people with thoracicoutlet syndrome have often had a recent injury to their nec#. "t is more common in peoplewhose jobs involve repetitive movements or in some athletes whose sport involves a lotof arm movement.

What are the sym!toms o# thoracic outlet syndrome?

$he symptoms of thoracic outlet syndrome depend on what is being compressed or s%uashed! in your thoracic outlet. As mentioned above, in most cases it is the nerves of the brachial plexus rather than blood vessels that are compressed. $herefore, symptomsare more li#ely to be due to nerve compression. owever, sometimes a combination of nerves and blood vessels may be compressed at the same time. $his can give rise to amixture of symptoms. +ymptoms are usually just felt on one side of the body. arely,

symptoms can occur on both sides.

Sym!toms due to nerve com!ression

$he symptoms depend on which nerves of the brachial plexus are compressed. ostcommonly you will develop pain and pins and needles in your hand and arm. You may

particularly feel these along the inside of your arm and into your ring and little finger.-ins and needles are usually worse at night time and can sometimes wa#e you from your


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sleep.

"f different brachial plexus nerves are compressed, you may have nec#, ear, upper bac#,upper chest and outer arm pain on the affected side. +ome people also have headaches.

Your affected arm may feel wea#. You may also notice that your affected hand gets verycold, especially in cold weather.

Sym!toms due to blood vessel com!ression or bloc$age

"n rare cases when your subclavian vein is compressed, your arm may become swollenand may sometimes appear a blue colour. $he swelling may lead to pins and needles inyour affected arm. +ome people also develop pain in their arm. $he symptoms tend tocome and go and may be brought on at times when you are using your arms a lot. "f youhave a blood clot in your subclavian vein causing bloc#age of the vein, these symptomswill become constant and urgent treatment is needed. "n rare cases, when your subclavian

artery is compressed, this means that blood is unable to get through to your arm and handon the affected side as readily as it should do. Again this can lead to pain and pins andneedles. Your arm and*or hand can appear pale white in colour and it can also feel cold.3i#e with the vein4related symptoms, the symptoms may be brought on by using your arms a lot.

How is thoracic outlet syndrome diagnosed?

Your doctor will usually start by as#ing you %uestions about your symptoms andexamining you. "f they suspect that you may have thoracic outlet syndrome, they may as# you to move your arms and shoulders into certain positions when they examine you. $hisis to try to induce, or bring on, your symptoms. $hey may then suggest certain tests toloo# for the underlying cause. 5sually, thoracic outlet syndrome is diagnosed after other conditions that can cause pain or pins and needles in one of your arms have beenexcluded. You may also be referred to a specialist.

A chest 64ray and 64ray of your nec# can show if you have a cervical rib. /ther testsincluding an " or &$ scan of your nec# and upper chest area may help to rule outother causes for your symptoms, such as arthritis in your nec# causing compression of thenerves in your nec#. +pecial tests called nerve conduction studies may sometimes besuggested. $hese loo# at the electrical activity of your nerves and can help to show whichnerves are being compressed.

"f your doctor suspects that you have compression of your subclavian artery or vein, other tests may be carried out to loo# for this. A test call angiography loo#s at your arteries andvenography loo#s at your veins. +pecial tests #nown as 7oppler studies can also loo# at

blood flow through your arteries and veins.

What is the treatment #or thoracic outlet syndrome?


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$reatment depends on the underlying cause.

%lood vessel com!ression or bloc$age

"n the rare case that you have bloc#age of one of your blood vessels by a blood clot, drug

treatment is needed urgently to brea# down the clot. $his drug treatment may then becontinued for a period of time to prevent further clots. +urgery may also be needed torelieve any compression on your blood vessels. 'or example, removal of a cervical ribthat may be s%uashing a blood vessel.

&erve com!ression

$here is not currently a consensus about what treatment is best for this type of thoracicoutlet syndrome. ore trials are needed to determine the best treatment. owever, ingeneral, treatment is aimed at relieving your symptoms. -hysiotherapy may be helpful for some people and may include stretching exercises, exercises to improve posture and

exercises to increase muscle strength and endurance. $hese exercises may all help toopen up the thoracic outlet and relieve the compression. You may also need to modify or change your wor# or sport activities. $his may involve loo#ing at the way that you sit in achair or at your des#. 7rugs such as non4steroidal anti4inflammatory drugs +A"7s! 4for example, ibuprofen 4 may be helpful in relieving pain in some people. -aracetamol or stronger pain#illers may sometimes be needed. A drug from a group called tricyclicantidepressants may also be suggested. $hey are not used here to treat depression.$ricyclic antidepressants can ease nerve pain in some people separate to their action ondepression. "t is thought that they wor# by interfering with the way nerve impulses aretransmitted.

"n some cases, surgery to relieve the cause of the compression may be advised. 'or example, to ease pressure from a cervical rib, or from an extra muscle or fibrous band inyour nec#, or to repair a bro#en collarbone that is pressing on nerves or blood vessels!.

owever, in many cases, surgery is not a good option and may even be harmful. $his is because there are many important structures in your thoracic outlet and there is a smallris# of damage to these with surgery. Your specialist will be able to advise if surgery is anoption.

What is the !rognosis 'outloo$( #or thoracic outletsyndrome?

"n most people with thoracic outlet syndrome, the outloo# is generally good andsymptoms often improve over time. "f compression or bloc#age of the subclavian arteryor vein is diagnosed %uic#ly and treated, a good recovery is possible. owever, nervecompression symptoms can be difficult to treat in a few people. &hronic persistent! painand wea#ness with some loss of ability to use the affected arm may be experienced bysome. $his can sometimes be severe enough to affect your %uality of life.


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