VERIFIED CONTENTAuthor: lek. Patryk Jasielski

The upper thoracic opening is a very important and complicated anatomical area. It consists of spine segments at the back, upper ribs on the side and the sternum in the front part. It forms the transition between the chest and neck. There are numerous muscle groups with fascial compartments. There are arterial and venous vessels, very important for the functioning, as well as nerves and nerve plexuses. So what is upper thoracic outlet syndrome?

Upper thoracic opening syndromeis a term used to describe the compression syndrome of the upper thoracic opening and related vascular and neurological symptoms in the upper limbs. Disorders are the result of pressure on the brachial plexus (which is a collection of nerves innervating the entire upper limb and armpit), the subclavian and / or axillary artery, and the subclavian and / or axillary vein. All these vessels are designed to supply blood to the armpit and upper limb.

Causes of the thoracic outlet syndrome

There are various reasons for this syndrome. All conditions leading to compression of vessels and nerves in the area of ​​their course in the thoracic opening, between the cervical spine and the armpit, may cause discomfort.

Causes can be congenital, such as:

  • additional cervical rib,
  • rib anomalies,
  • invalid trailers
  • and the course of the muscles around the neck.

The syndrome can also be the result of poor posture. Incorrect body position during work, hard physical work or strenuous exercise in the gym are among the more common causes. A very slim figure as well as overdeveloped muscles of the shoulder girdle and chest may predispose to the compression syndrome.

Another potential cause are injuries to the shoulders, spine, collarbone and first rib fractures.

Symptoms of thoracic outlet syndrome

Ailments usually appear between the ages of 30 and 40. They are most often the result of pressure on the nerves. Pain is observed in the cervical spine or in the shoulder girdle and deep inside the shoulder. It can radiate to the head along the medial surfacearm and forearm, up to the 4th and 5th finger.

There is also a tingling sensation and numbness throughout the upper arm and forearm and hand. Weakened sensation, hand hypersensitivity to cold and its cooling down are other observed symptoms.

In more advanced syndromes, the strength of the hand muscles may weaken, it is impossible to perform precise movements and the muscles in the hand are atrophied. When the vein is pressed with the hand, it is swollen. The skin has a purporous red color. There are dilated veins in the upper limb and chest area and a net of fine veins.

Pressure on an artery can lead to acute ischaemia of the hand with its paleness, sudden loss of strength and increased sensory disturbance. In the chronic syndrome, digital ulcers and necrosis are visible.

The appearance or intensification of symptoms depending on the position of the upper limb is very characteristic of the compression syndrome of the upper chest. Raising or lifting the arm causes discomfort. This can make your work and daily duties much more difficult.

The appearance or intensification of symptoms depending on the position of the upper limb is very characteristic of the compression syndrome of the upper chest. Raising or lifting the arm causes discomfort. This can make your work and daily duties much more difficult.

Diagnosis of the thoracic outlet syndrome

In order to establish a diagnosis, a potential cause is searched for. At the beginning, the doctor performs provocation tests (such as the Adson test or hyperabduction) in order to intensify the existing pressure on the subclavian vessels and the brachial plexus.

To detect bone anomalies, X-rays of the neck, chest and shoulders are performed. Vessel ultrasound with the function of assessing blood flow through the arteries and veins (Doppler examination) allows you to check whether the blood in the subclavian vessels is flowing properly. You can also check the blood pressure in the arteries during ultrasound.

Arteriography is performed less frequently. It is an examination in which a special contrast agent is injected into the artery and its flow is monitored with the help of a series of x-rays. This allows you to judge what the lumen of the arteries looks like.

The doctor can also check if there is any pressure on the nerves and if they are not damaged, as well as the innervation of the muscles. For this purpose, electromyographic tests are used, in which the innervation of the small muscles of the hand is assessed.

The second test is an electroneurographic test that checks your nerve conduction ability to see if it is disturbed.

Treatment of the upper cage opening syndromechest

The method of therapy depends on the severity of the symptoms and the detected cause of the disease. Conservative and surgical treatment is applied.

With mild symptoms and no arterial flow disturbances, treatment is based on several months of rehabilitation and physiotherapy aimed at strengthening the muscles of the shoulder girdle.

Surgical treatment is used in advanced cases. Additional cervical ribs or 1st thoracic rib are removed. Neck muscles are removed or incised. When the arteries are narrowed or blocked, they are expanded and stents inserted (this is a percutaneous angioplasty procedure). If you see blood clots in a vein, you can treat them with medicines to dissolve the clot. Symptoms include painkillers and anti-inflammatory drugs.

Upper thoracic outlet syndrome is a fairly common condition. It can cause different symptoms depending on the location and intensity of the pressure. Symptoms may be slightly increased, but they can also significantly hinder work and daily functioning.

If you experience pain or tingling in your upper limb, especially when lifting or abducting it, consult your doctor.

Ignoring symptoms can aggravate symptoms and lead to irreversible muscle atrophy. Therapy based on physiotherapy, if implemented early enough, makes it possible to avoid the need for surgery.

Category:

Neurology