Thoracic outlet syndrome denote a group of ill-defined disorders that are characterized by pain and paresthesias in one hand, in the neck, a shoulder or arm. They seem to compression of the brachial plexus (and perhaps the subclavian vessels) to include, as these structures pass through the thoracic inlet. Diagnostic methods are not established. The treatment includes physical therapy, analgesics, and, in severe cases, surgical measures.

(See also summary of disorders of the peripheral nervous system.)

Thoracic outlet syndrome denote a group of ill-defined disorders that are characterized by pain and paresthesias in one hand, in the neck, a shoulder or arm. They seem to compression of the brachial plexus (and perhaps the subclavian vessels) to include, as these structures pass through the thoracic inlet. Diagnostic methods are not established. The treatment includes physical therapy, analgesics, and, in severe cases, surgical measures. (See also overview of disorders of the peripheral nervous system.) The pathogenesis is often unclear, but sometimes includes a compression of the lower trunk of the brachial plexus (and perhaps the subclavian vessels), as these structures, the thoracic inlet below the Mm. scaleni and cross above the first rib, before entering into the axilla; However, this involvement is unclear. The compression can be caused by a cervical rib An abnormal 1st thoracic rib Abnormal insertion or position of the scalene scalene muscles a badly healed clavicular fracture thoracic outlet syndrome are more common in women and usually develop between the ages of 35 and 55. Symptoms and complaints pain and paresthesias usually begin in the neck or shoulder and may spread to the medial aspect of the arm and hand and sometimes up in the adjacent lateral thoracic region. Many patients have mild to moderate sensory disturbances in the innervation of the roots C8-T1 on the painful side; few have significant vegetative vascular changes in the hand (eg. as cyanosis, swelling). With even less patient all the affected hand is paretic. Rare complications include Raynaud’s syndrome and a distal gangrene. Diagnosis Clinical assessment Electro-diagnostic testing and usually MRI of the brachial plexus and / or cervical spine The diagnosis of thoracic outletcompression- syndrome is suspected due to the proliferation of symptoms. Various maneuvers are recommended to show the compression of vascular structures (eg., By stretching of the brachial plexus), but sensitivity and specificity are low. Sounds on auscultation in the area of ??the clavicle or the apex of the axilla or the finding of a neck rib in the X-ray image can deliver diagnostic indications. Although angiography can demonstrate a kinking or partial obstruction of arteries or veins in the axilla, no test result should be regarded as the undisputed evidence of the existence of the disease. An electro-diagnostic testing must be ensured in all patients with symptoms suggesting, and it is an MRI of the brachial plexus and / or cervical required. Treatment Physical therapy and analgesics in more serious cases surgical procedures, most patients without objective neurological deficits respond to physical therapy, NSAIDs and low-dose tricyclic antidepressants on. If compression is demonstrated by a cervical rib or subclavian artery, an experienced specialist should decide whether surgery is necessary. With few exceptions, surgical intervention should be reserved for patients who have significant or progressive neurovascular deficits and do not respond to conservative treatment. Conclusion Pull these syndromes into consideration in patients with unexplained pain and paresthesias that begin in the neck or shoulder and spread to the medial arm. Do a electrodiagnostic testing and usually an MRI of the brachial plexus by and / or the cervical spine. Treat most patients with analgesics and physical therapy. Drag a surgery considered when patients have subclavian and neurovascular deficits compression by a cervical rib or an A., progressing despite conservative treatment.

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