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Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) become compressed. This can cause pain in your shoulders and neck and numbness in your fingers.
Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. Sometimes doctors can't determine the cause of thoracic outlet syndrome.
Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these approaches. In some cases, however, your doctor may recommend surgery.
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Generally, there are three types of thoracic outlet syndrome.
Neurogenic (neurological) thoracic outlet syndrome. This form of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand.
In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic.
Nonspecific-type thoracic outlet syndrome. This type is also called disputed thoracic outlet syndrome. Some doctors don't believe it exists, while others say it's a common disorder.
People with nonspecific-type thoracic outlet syndrome have chronic pain in the area of the thoracic outlet that worsens with activity, but the specific cause of the pain can't be determined.
Neurogenic (neurological) thoracic outlet syndrome. This form of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand.
In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic.
Nonspecific-type thoracic outlet syndrome. This type is also called disputed thoracic outlet syndrome. Some doctors don't believe it exists, while others say it's a common disorder.
People with nonspecific-type thoracic outlet syndrome have chronic pain in the area of the thoracic outlet that worsens with activity, but the specific cause of the pain can't be determined.
Thoracic outlet syndrome symptoms can vary, depending on which structures are compressed. When nerves are compressed, signs and symptoms of neurological thoracic outlet syndrome include:
Signs and symptoms of vascular thoracic outlet syndrome can include:
See your doctor if you consistently experience any of the signs and symptoms of thoracic outlet syndrome.
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In general, the cause of thoracic outlet syndrome is compression of the nerves or blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include:
Repetitive activity. Doing the same thing repeatedly can, over time, wear on your body's tissue.
You may notice symptoms of thoracic outlet syndrome if your job requires you to repeat a movement continuously, such as typing on a computer, working on an assembly line or lifting things above your head, as you would if you were stocking shelves.
Athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements.
Repetitive activity. Doing the same thing repeatedly can, over time, wear on your body's tissue.
You may notice symptoms of thoracic outlet syndrome if your job requires you to repeat a movement continuously, such as typing on a computer, working on an assembly line or lifting things above your head, as you would if you were stocking shelves.
Athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements.
Source: http://www.mayoclinic.com
At Mayo Clinic, we take the time to listen, to find answers and to provide you the best care.
Diagnosing thoracic outlet syndrome can be difficult because the symptoms and their severity can vary greatly among people with the disorder. To diagnose thoracic outlet syndrome, your doctor may review your symptoms and medical history and conduct a physical examination.
Provocation tests are designed to reproduce your symptoms. The tests may help your doctor determine the cause of your condition and help rule out other causes that may have similar symptoms.
In these tests, your doctor may ask you to move your arms, neck or shoulders in various positions. Your doctor will assess your symptoms and examine you in different positions.
To confirm the diagnosis of thoracic outlet syndrome, your doctor may order one or more of the following tests:
Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your body. A dye may be injected into a vein to view the blood vessels in greater detail (CT angiography).
A CT scan may identify the location and cause of blood vessel (vascular) compression.
Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your body.
Your doctor may use an MRI to determine the location and cause of blood vessel (vascular) compression. An MRI may reveal congenital anomalies, such as a fibrous band connecting your spine to your rib or a cervical rib, which may be the cause of your symptoms.
Doctors don't often use this test to diagnose thoracic outlet syndrome. However, imaging tests may rule out other conditions that may be causing your symptoms, such as spine or brain conditions.
Arteriography and venography. In these tests, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is moved through your major arteries in arteriography, or through your veins in venography, to the affected blood vessels. Then your doctor injects a dye through the catheter to show X-ray images of your arteries or veins.
Doctors can check to see if you have a compressed vein or artery. If a vein or artery has a clot, doctors can deliver medications through the catheter to dissolve the clot.
Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your body. A dye may be injected into a vein to view the blood vessels in greater detail (CT angiography).
A CT scan may identify the location and cause of blood vessel (vascular) compression.
Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your body.
Your doctor may use an MRI to determine the location and cause of blood vessel (vascular) compression. An MRI may reveal congenital anomalies, such as a fibrous band connecting your spine to your rib or a cervical rib, which may be the cause of your symptoms.
Doctors don't often use this test to diagnose thoracic outlet syndrome. However, imaging tests may rule out other conditions that may be causing your symptoms, such as spine or brain conditions.
Arteriography and venography. In these tests, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is moved through your major arteries in arteriography, or through your veins in venography, to the affected blood vessels. Then your doctor injects a dye through the catheter to show X-ray images of your arteries or veins.
Doctors can check to see if you have a compressed vein or artery. If a vein or artery has a clot, doctors can deliver medications through the catheter to dissolve the clot.
Source: http://www.mayoclinic.com
If you haven't been treated early in the condition, soon after you noticed symptoms, then you may experience progressive nerve damage, and you may require surgery.
Doctors recommend surgery to treat thoracic outlet syndrome only when other treatments haven't been effective. Surgery has higher risks than do other treatments and may not always treat your symptoms.
Source: http://www.mayoclinic.com
Thoracic outlet syndrome that goes untreated for years can cause permanent neurological damage, so it's important to have your symptoms evaluated and treated early, or take steps to prevent the disorder.
If you're susceptible to thoracic outlet compression, avoid repetitive movements and lifting heavy objects.
If you're overweight, you can prevent or relieve symptoms associated with thoracic outlet syndrome by losing weight.
Even if you don't have symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder, because this can increase pressure on the thoracic outlet.
Stretch daily, and perform exercises that keep your shoulder muscles strong.
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If you're diagnosed with thoracic outlet syndrome, your doctor or physical therapist will instruct you to do exercises at home to strengthen and support the muscles surrounding your thoracic outlet.
In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet:
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Symptoms associated with thoracic outlet syndrome can be caused by a number of other conditions, which makes it difficult for doctors to diagnose the condition. Many people experience thoracic outlet syndrome symptoms for years before they are diagnosed with the condition, which can cause stress and frustration.
Be sure to discuss your concerns with your doctor if your symptoms persist and a diagnosis hasn't been made.
Source: http://www.mayoclinic.com
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