Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves
in the space between your collarbone and your first rib are compressed.
Neurogenic Thoracic outlet syndrome occurs when the nerves leading from the neck to the arm (the brachial plexus) is compressed.
symptoms are:
Pain or weakness in the shoulder and arm
Weakening grip
Tingling or discomfort in the fingers
Arm fatigue with activity
Symptoms may come and go, but they are often made worse when arms are held up.
The longer the arms stay up, the worse the symptoms can get.
Venous Thoracic outlet syndrome occurs when the subclavian vein is compressed,
leading to upper body thrombosis.
symptoms are:
swelling of the arm, hand or fingers
Blueness of the hand and arm
Painful tingling in the hand and arm
Very prominent veins in the shoulder, neck and hand
Arterial Thoracic outlet syndrome occurs when the subclavian artery is compressed.
symptoms are:
Cold and pale hand
Pain in the hand and arm, especially during overhead motions of the arm
blood clots of an artery in the hand or arm
Aneurysm of the subclavian artery manifest throbbing lump near the collarbone
Weak or no pulse in the affected arm
Treatment
Your doctor may prescribe anti-inflammatory medications, pain medications
or muscle relaxants to decrease inflammation, reduce pain and encourage muscle relaxation.
If you have venous or arterial thoracic outlet syndrome,
your doctor may prescribe medications to prevent blood clots or clot-dissolving medications
Physical Therapy should be the first strategy to treat thoracic outlet syndrome
since this seems to be effective at decreasing symptoms, facilitating return to work and improving function,
physical therapy focuses mainly on patient education, paincontrol, range of motion, strengthening and stretching.
Most patients experience an improvement in symptoms after undergoing physical therapy.
A small amount of Botox injected into the tight or spastic scalene muscles found in thoracic outlet syndrome sufferers
often provides months of relief while the muscle is temporarily paralyzed.
The relief of symptoms from a Botox injection generally lasts 3-4 months
In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet:
Maintain good posture
Take frequent breaks at work to move and stretch
Avoid carrying heavy bags over your shoulder
Avoid activities that worsen symptoms,
or find ways to adapt activities so that they don't cause symptoms
Gently massage your shoulders and thoracic outlet
Apply a heating pad to the area
Practice relaxation exercises such as deep breathing,
Your doctor may recommend surgery if other treatment hasn't been effective for 6 months,
if you're experiencing ongoing symptoms
or if you have progressive neurological problems.
A surgeon trained in thoracic surgery or vascular surgery will perform the procedure.
in some cases of vascular thoracic outlet syndrome,
your surgeon may conduct a procedure to remove a clot from the vein or artery
or repair the vein or artery prior to thoracic outlet decompression.
If you have arterial thoracic outlet syndrome, your surgeon may need to replace the damaged artery with a graft.
This procedure may be done at the same time as your procedure to have the first rib removed.
rehabilitation
One of the most important factors after surgery is good pain control
Respiratory exercises should be done every 1-2 hours when you are awake.
you should gently swing the hand different directions 5 times daily during the first week
Avoid any heavy lifting or strenuous exercise for a month after the operation.
post-operative physical therapy is a very important aspect of recovery
and it is usually initiated between three to five weeks from the surgery
depending on the recovery and pain control.
You should not drive a car until cleared by your doctor
usually 6 weeks after surgery
you will be able to return to sport 6 months to 1 year after surgery.
15 сен 2024
