Causes and risk factors
Injury is one of the major contributing factors for this syndrome. Weakness of the shoulder muscle is the main contributing factor for this condition. Trauma caused due to severe blow or vehicle accidents adds up to the causation. Presence of rudimentary first rib leads to compression. Certain other factors like poor posture and being overweight also adds up to the list. Although it is still not clear, psychological factors can also lead to thoracic outlet syndrome. Certain other risk factors like tumors of the neck, injury to the neck, enlargement of the lymph nodes, heavy sports and activity can also be responsible for this.
Clinical presentation:
Weak shoulder muscles which are unable to help the clavicle in its position can cause compression of its contents. The patient can come up with a variety of complaints. The symptoms vary as per the structure involved. Compression of the blood vessels causes swelling and redness of the upper extremity. The hands are cold to touch. Discoloration of the upper extremities is commonly seen. Restriction of movement is seen. The patient faces difficulty in lifting the hand above the head. As the collarbone is displaced, swelling is seen in the shoulder area. Compression of nerve leads to pain in neck and shoulder; the pain radiates down to the palm and fingers. The hands become weak, hence clumsiness along with weak grip occurs. Numbness and tingling also occur.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the patient and the physical examination carried out by the orthopedic doctor. Certain physical tests are carried out by the doctor. Elevated arm stress test is diagnostic. X-ray is done to detect any fracture or underlying cause. Nerve conduction tests are also done. MRA scan or CT scan can also be suggested.
Treatment:
Rest and restriction of movement, which causes pain, is the first step involved. Analgesic or nonsteroidal anti-inflammatory drugs are advised by the orthopedic doctor. Anticoagulants and thrombolytic medications are also advised. Ice pack application can be advised which will help to relieve the swelling, if any. If the conservative treatment fails to be effective, then surgical intervention is needed. Surgery needs to be done to relieve the compression of nerves or any arterial or venous blockages. It aims at relieving the compression. Certain physical exercises are advised to strengthen the muscle and improve the flexibility. In overweight subjects, weight reduction is advised.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
