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Thoracic Outlet Syndrome
What is it?
Thoracic outlet syndrome is a repetitive stress disorder that involves the shoulder and upper arm.
What causes it?
The thoracic outlet is a triangular area through which nerves and blood vessels pass from the neck to the arm. The area is bordered by the collar bone, the first rib, and the anterior and middle scalene muscles. Thoracic outlet syndrome occurs when the nerves and blood vessels between the neck and shoulder are compressed. Activities such as pulling your shoulders back and down (an exaggerated military stance), sleeping with your arms above your head, carrying items such as a stretcher, backpack, or suitcase or work that requires frequent overhead lifting may increase the risk of this syndrome.
Symptoms
Symptoms are similar to carpal tunnel syndrome – numbness in the fingers and hand, tingling in the arm as if it is "asleep", and pain that begins in the base of the neck and radiates into the arm or hand.
Initial evaluation
The physician will examine your arm, shoulder and neck and ask you about your medical history, any injuries you may have sustained to your arm, the job that you perform, hobbies or sports you participate in, etc. An X-ray or other lab tests may be performed to rule out other causes of your symptoms.
Treatment
The mainstay of treatment is physical therapy. The goals are to modify postural habits, relieve muscle tension, improve alignment and increase nerve gliding. Rest, adjustments to how you perform daily activities, oral anti-inflammatory medications and steroid injections may be recommended. If non-surgical treatment is not successful or treatment is sought too late, surgery may be required. The two procedures available are release of the scalene muscles, or excision of the first rib. Both procedures provide improvement in approximately 80% of properly selected patients, but over time 10% of the patients develop recurrent symptoms. The physicians at The Curtis National Hand Center prefer to release the scalene muscles, as this procedure is less invasive, has equal results and fewer risks. The procedure is performed as an inpatient and generally requires several months for full recovery. Surgery is followed by therapy lasting 1-3 months.
Call 1-877-UMH-HAND (1-877-864-4263) for a referral to one of our doctors, or request an appointment.
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