The thoracic outlet syndrome is a canalicular syndrome that affects the brachial plexus, that is to say that complex of nerves coming out of the cervical spine and innervating the upper limbs. Parallel to the nerve bundles, the veins and arteries running towards the arms also run.
This bundle of vessels and nerves can be compressed in its course at three points, each sustained by a precise or in any case frequent cause:
- the interscalenic triangle formed by the three scalene muscles, lateral to the cervical column, where it assumes the more precise name of scalene syndrome,
- the sub-clavicular or cost-clavicular space, usually called in this case cervical rib syndrome,
- the subcoracoid space, below the pectoralis minor muscle, and in this case it will give the so-called hyperabduction syndrome.
This area can be excessively stressed by postures or work movements, especially in the presence of congenital anatomical changes, such as the supernumerary rib, the mega-transverse C7, or acquired, such as fibrosis or spasms of the scalene muscles. Even whiplashes can become triggering events such as overworked shoulders and upper limbs.
Thoracic outlet syndrome manifests as tingling, swelling or cold in the hands, even bilateral, often at night. Generally the symptoms become more pronounced after a particularly tiring day. The same symptoms can appear when holding arms up for a long time: in this case patients also feel a strong tiredness in their arms. Often this pathology amplifies other neurogenic problems of the upper limb, such as the carpal tunnel.
The symptoms are often made worse by the abduction of the arms. On the neurological side we have pain, numbness, paresthesia, and a sense of weakness, while vascular-type symptoms are pain, loss of arterial pulse, cold limb and pallor, and sometimes swelling of the hands.
Currently there is no single clinical sign that makes the diagnosis of thoracic outlet syndrome with any degree of certainty. For this reason, several tests are added that evaluate the presence or absence of the radial pulse during particular positions of the arms and neck. The result of these tests, combined with the symptoms reported by the patient and possibly with radiological control, can make the diagnosis of thoracic outlet syndrome.
There are three main types of thoracic outlet syndrome, named according to the cause of the symptoms:
- neurogenic thoracic outlet syndrome;
- arterial thoracic outlet syndrome;
- venous thoracic outlet syndrome.
However, this classification is only scholastic and in the daily clinic job a thoracic outlet syndrome can involve all types of compression in varying degrees. Furthermore, the compression forces can be of different amplitude in each structure concerned. Therefore, the symptoms can be variable and this often makes the precise diagnosis complex.
Cures and remedies
Generally, thoracic outlet syndrome, except in rare surgical cases, is treated with physiotherapy. For us at Nervenia the resolution of the problem goes through three fundamental approaches:
– relaxation of the lateral neck muscles,
– releasing nerve tissue mobility,
– stimulation of nervous function.
For this reason the treatment uses both manual and instrumental techniques in the area of the thoracic outlet and then with deep nerve stimulation (Deep Nerve Stimulation – DNS), a particular type of current that acts specifically on the conduction disorders of peripheral nervous tissue and allows to restore the correct functionality of irritated and damaged nerves by compression.