Thoracic Outlet Syndrome: Causes, Symptoms and Treatment

Thoracic outlet is situated in the area between the neck and the chest which is right at the top of the ribcage. It constitutes various anatomical structures which passes through this area and are very complicated in nature. It includes esophagus, trachea, nerves and blood vessels. Thoracic outlet syndrome causes severe pain in the region of neck, shoulder, chest, arm, and/or hand. The reason behind the pain is the compression of blood vessels and nerves which directly affects the thoracic region and causes pain and abnormal sensations.

People suffering from thoracic outlet syndrome often confuse it with angina pain, which occurs during a heart attack. The angina pain and the pain in thoracic outlet is quite different. In angina, the pain appears while walking and in thoracic outlet syndrome it does not appear while walking. Secondly, the pain can be felt when the arm is raised, while it is not the case with angina pain.

Types and Symptoms of Thoracic Outlet Syndrome

• True Neurogenic: This is a rare disorder which is caused by congenital anomalies. It is found mainly in middle-aged women and occurs on one side of the body. The symptoms include weakness and wasting of hand muscles and numbness in hand.
• Arterial: It affects both the genders equally but mostly seen in young people. It is caused due to congenital anomaly and affects one side of the body. Cold sensitivity in the hands and fingers, pain and numbness in fingers, finger sores and inadequate blood circulation are the symptoms of arterial thoracic syndrome.
• Disputed: As the name suggests there is a dispute among doctors about its existence. It is caused due to nerve injury in the brachial plexus. The symptoms are pain, weakness and fatigue.
• Venous: The actual cause of venous thoracic syndrome is unknown. It targets both the genders and often caused due to unusual and prolonged limb exertion. It is also known as Paget-Schroetter Syndrome and sometimes called Effort Thrombosis. The symptoms are pain and swelling of arms.
• Traumatic: It is caused due to traumatic injury or repetitive activities. The symptoms are pain, burning sensations in hands, arms, legs or feet. The symptoms get worse if the body posture is not right.

Causes
There are various factors which contributes to thoracic outlet syndrome. A person's overall physical structure can cause this syndrome; the abnormal anatomy may exert pressure on the nerves or blood vessels. Malformed ribs, and too narrow opening between the collar bones and the first rib are some of the abnormalities which can cause thoracic outlet syndrome. Poor posture is one of the leading causes which can be easily worked upon. A major symptom is pain in the affected area, the patient's arms and hands become weak. When the patient is exposed to cold, small arteries in the finger contract and turn pale. In severe cases, it can lead to gangrene due to compression of blood vessels. This condition is called Raynaud's syndrome.

Treatment
There are no particular diagnostic tests which can detect the syndrome. The diagnosis is done after ruling out possibilities of other diseases and assessing the overall condition of the patient. Tests such as Adson test and Allen test can be used to detect the presence of thoracic outlet syndrome. Other tests such as chest X-ray, color flow duplex scanning, ultrasound analysis also helps to diagnose the ailment. Physical therapy can be helpful in treating thoracic outlet syndrome. The main area of consideration is to improve the posture of the affected person. In rare cases, surgery is performed when physical therapy doesn't work. Exercises done on a regular basis on consultation of a doctor can help in treating thoracic outlet syndrome effectively.