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Adrian Torres
Adrian Torres

Thoracic Outlet Syndrome Treatment Pdf Free

Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. Thoracic outlet syndrome is named for the space (the thoracic outlet) between your lower neck and upper chest where this grouping of nerves and blood vessels is found.

thoracic outlet syndrome treatment pdf free

Thoracic outlet syndrome affects people of all ages and gender. The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, volleyball, and other sports.

The pain of TOS is sometimes confused with the pain of angina (chest pain due to an inadequate supply of oxygen to the heart muscle), but the two conditions can be distinguished because the pain of thoracic outlet syndrome does not occur or increase when walking, while the pain of angina usually does. Additionally, the pain of TOS typically increases when raising the affected arm, which does not occur with angina.

Signs and symptoms of TOS help determine the type of disorder a patient has. Thoracic outlet syndrome disorders differ, depending on the part(s) of the body they affect. Thoracic outlet syndrome most commonly affects the nerves, but the condition can also affect the veins and arteries (least common type). In all types of TOS, the thoracic outlet space is narrowed, and there is scar formation around the structures.

The disorders caused by TOS are not well understood. Yet, it is known that when the blood vessels and/or nerves in the tight passageway of the thoracic outlet are abnormally compressed, they become irritated and can cause TOS. Thoracic outlet syndrome can be a result of an extra first rib (cervical rib) or an old fracture of the clavicle (collarbone) that reduces the space for the vessels and nerves. Bony and soft tissue abnormalities are among the many other causes of TOS. The following may increase the risk of developing thoracic outlet syndrome:

Early identification of TOS can help improve the success of treatment. Thoracic outlet syndrome treatments vary, depending on the type of TOS you have and your symptoms. The goals of treatment are to reduce symptoms and pain. Your health care provider will recommend the treatment option that is right for you.

To reduce the risk of blood clots and pulmonary embolism, treatment for venous thoracic outlet syndrome may include thrombolytic (clot-busting) or anticoagulant (blood thinning) medications and surgery. In many cases, the patient will be treated with thrombolytic medications and start anticoagulation therapy before surgery.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause shoulder and neck pain and numbness in your fingers.

Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. Sometimes doctors don't know the cause of thoracic outlet syndrome.

Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these treatments. In some cases, however, your doctor may recommend surgery.

Thoracic outlet syndrome is usually caused by compression of the nerves or blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include:

If you're at risk for thoracic outlet compression, avoid repetitive movements and lifting heavy objects. If you're overweight, losing weight may help you prevent or relieve symptoms of thoracic outlet syndrome.

Even if you don't have symptoms of thoracic outlet syndrome, avoid carrying heavy bags over your shoulder, because this can increase pressure on the thoracic outlet. Stretch daily, and perform exercises that keep your shoulder muscles strong.

TOS affects approximately 8% of the population and is 3-4 times as frequent In woman as in men between the age of 20 and 50 years. Females have less-developed muscles, a greater tendency for drooping shoulders owing to additional breast tissue, a narrowed thoracic outlet and an anatomical lower sternum, these factors change the angle between the scalene muscles and consequently cause a higher prevalence in women.[4][5][6] The mean age of people effected with TOS is 30s-40s; it is rarely seen in children. Almost all cases of TOS (95-98%) affect the brachial plexus; the other 2-5% affecting vascular structures, such as the subclavian artery and vein.

Signs and symptoms of thoracic outlet syndrome vary from patient to patient due to the location of the nerve and/or vessel involvement. Symptoms range from mild pain and sensory changes to limb-threatening complications in severe cases.

Patients with thoracic outlet syndrome will most likely present pain anywhere between the neck, face and occipital region or into the chest, shoulder and upper extremity and paresthesia in the upper extremity. The patient may also complain of altered or absent sensation, weakness, fatigue, a feeling of heaviness in the arm and hand. The skin can also be blotchy or discoloured. A different temperature can also be observed.

There are four categories of thoracic outlet syndrome and each presents with unique signs and symptoms (see Table 1). Typically TOS does not follow a dermatomal or myotomal pattern unless there is nerve root involvement, which will be important in determining your PT diagnosis and planning your treatment [3][4].

Compressors* - a patient that experiences symptoms throughout the daytime while using prolonged postures resulting in increased tension or compression of the thoracic outlet. The most common aggravating postures are head forward with the shoulder girdles protracted and depressed or activities that involve working overhead with the arms elevated. These positions cause an increase in tension/compression (such as working overhead with elevated arms) that would result in an increase in tension or compression of the neurovascular bundle of the brachial plexus

Releasers* - Describes patients that often experience paraesthesia at night that often wakes them up. It is caused by a release of tension or compression to thoracic outlet, that restores the perineural blood supply to the brachial plexus, signalling a return of normal sensation. This is used as an indicator of a favourable outcome and resolution of symptoms.

Nonsteroidal anti-inflammatory drugs have been prescribed to reduce pain and inflammation. Botulinum injections to the anterior and middle scalenes have also found to temporarily reduce pain and spasm from neurovascular compression, further research is needed because there are discrepancies in the literature.[19][20][21] Surgical management of TOS should only be considered after conservative treatment has been proven ineffective.[22]However, limb-threatening complications of vascular TOS have been indicated for surgical intervention.[23]Surgery to treat thoracic outlet syndrome may be performed using several different approaches, including: transaxillary approach, supraclavicular approach and infraclavicular approach.[22]

In venous or arterial TOS, medication can be administered to dissolve blood clots prior to thoracic outlet compression. It may also be to conduct a procedure to remove a clot from the vein or artery or repair the vein or artery prior to thoracic outlet decompression.[27]

Some larger-chested women have sagging shoulders that increase pressure on the neurovascular structures in the thoracic outlet. A supportive bra with wide and posterior-crossing straps can help reduce tension. Extreme cases may resort to breast-reduction surgery to relieve TOS and other biomechanical problems.[7][16][18]

Hooper T, Denton J, McGalliard M, Brismée J, Sizer P. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. Journal Of Manual and Manipulative Therapy. June 2010;18(2):74-83.

Hooper T, Denton J, McGalliard M, Brismée J, Sizer P. Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management. Journal of Manual and Manipulative Therapy. June 2010;18(3):132-138.

The Thoracic Outlet Syndrome Program in the Division of Thoracic Surgery at Massachusetts General Hospital provides expert diagnosis, treatment and support to patients with thoracic outlet syndrome (TOS).

Our doctors and nurses are highly skilled in properly diagnosing and treating thoracic outlet syndrome. Because of the pioneering work that our providers have done in all areas of TOS and their experience in treating both common and complex cases, the Thoracic Outlet Syndrome Program at Mass General is a major referral center for this disorder, helping patients from all over the U.S. and globally. Our physicians and care team have a long-standing history of offering solutions for patients whose prior treatments were unsuccessful.

Thoracic outlet syndrome is a group of disorders that occur when the nerves in the brachial plexus and the blood vessels of the subclavian artery and subclavian vein are compressed in the anatomic region known as the thoracic outlet (between the collarbone and the first rib). This includes the area from the neck to the underarm.

Though it tends not to become prevalent until teenage years or young adulthood, thoracic outlet syndrome can occur across all ages and genders. Our team treats adults, young adults and pediatric patients whose TOS developed for a variety of reasons, including athletics.


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