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Thoracic Outlet Syndrome: Squaring your shoulders against vascular disease
Omar P. Haqqani, MD
Midland Daily News
December 25, 2016
Thoracic outlet syndrome (TOS) is a disorder that compresses the blood vessels or nerves between the collarbone and first rib — similar to how water flow is interrupted when stepping on a garden hose. Though not life-threatening, failure to treat this condition soon after first noticing symptoms could result in irreparable nerve damage, and may even require surgery.
When the restriction of blood flow through the vessels occurs, the region fails to effectively communicate with the brain, often resulting in neck and shoulder pain, as well as numbness in the fingers.
Over time, the lack of blood flow and damage to the nerves can also lead to a weakened grip, making grasping items difficult.
There are three types of TOS: Neurogenic, venous and arterial. Though there are a number of common causes for TOS, diagnosis is typically determined by a patient’s symptoms and lifestyle.
Neurogenic TOS is the compression of the brachial plexus — a network of nerves that derive near the neck and shoulder, typically affecting those who frequently engage in overhead arm activities. Patients may experience symptoms when performing daily activities, such as combing their hair, or engaging in physical activities, such as pitching or swimming.
Symptoms of Neurogenic TOS include a pins and needles sensation in the fingers and hand, a change in hand color, and a dull, aching pain in the neck, shoulder or armpit. Some patients also experience muscle wasting in the fleshy base of the thumb, referred to as the Gilliatt-Sumner hand — a characteristic sign in Neurogenic TOS.
Neurogenic TOS is the most common form of the condition, and physical therapy is generally helpful in a patient’s road to recovery.
Venous TOS, or compression between the clavicle and first rib, normally affects 10-15 percent of all patients suffering from the condition. Symptoms of Venous TOS include pain, swelling, heaviness, or bluish discoloration of the upper arm.
Arterial TOS is the compression of the subclavian artery, which can lead to the development of regional blockages or aneurysms. Those affected by Arterial TOS may experience symptoms such as numbness and tingling in the hands or feet, cold or pale fingers, chronic arm fatigue and non-healing wounds or ulcerations in the fingers.
Common causes of TOS are often a result of physical trauma, most commonly from a car accident, or repetition from job related activities, such as typing or assembly line work. Anatomical defects, such as having an extra rib, habitual poor posture, or pregnancy are also common causes of TOS.
However, not all causes of thoracic outlet syndrome are able to be determined.
Females are more likely to be diagnosed with TOS than males are, and the condition is more commonly found in young adults between the ages of 20 and 40 — though people of all ages are susceptible.
A diagnosis can be confirmed through one or more tests, including X-ray, ultrasound, computerized tomography scan (CT), angiography and venography.
If the condition is diagnosed early, a conservative approach to treatment is often effective, which usually involves a combination of physical therapy and medication.
Physical therapy focuses on strengthening the shoulder muscles and improving range of motion. Medications can include anti-inflammatories, pain relievers, muscle relaxants and anticoagulants.
If physical and medical therapies aren’t enough to resolve the condition, however, surgery may be necessary. A vascular specialist can perform procedures through several different approaches.
Luckily, TOS is preventable. To decrease the risk of developing this condition, it’s important to avoid unnecessary stress on the shoulders and muscles surrounding the thoracic outlet region.
To do this, it is important to keep good posture, take frequent breaks at work to move and stretch, avoid carrying heavy bags on the shoulders for extended periods of time, create a work area that allows for free movement and maintain a healthy weight.
If you are experiencing symptoms of thoracic outlet syndrome, don’t hesitate to consult with your physician about diagnosis and treatment to avoid unwanted complications. However, with there being many common symptoms that underlay a vascular etiology, consulting with a vascular specialist to determine the causation is also recommended.
In my experience, patients with TOS suffer for many years before they are given a diagnosis and treatment to relieve their symptoms. Early detection and diagnosis can help minimize complications, and make all the difference when faced with TOS.
Dr. Omar P. Haqqani, MD is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.
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