The symptoms of thoracic outlet syndrome occur due to compression of nerves arising from the brachial plexus. It may also occur due to the compression of blood vessels in this region. This article provides some information on the symptoms and diagnosis of the syndrome.
The thoracic outlet syndrome is a spectrum of disorders involving compression at the superior thoracic outlet, which affects the nerves of the brachial plexus. The brachial plexus anatomy is complicated and there are nerve roots, trunks, divisions, and cords present. The affected individual may experience certain symptoms due to compression of the nerves, as well as the subclavian artery and vein. These symptoms are mostly neurological in nature. They are more commonly observed in people affected by neck injuries caused due to motor vehicle accidents, and those using computers for extended periods of time in faulty positions. This condition might be observed in overzealous athletes and musicians at times.
The Main Symptoms
- Swelling or puffiness in the arm may be observed due to the compression of an artery or a vein.
- Cyanosis, that is, bluish discoloration of the arm may be observed. This occurs due to an inadequate amount of oxygen reaching the arm.
- If a nerve is compressed, then the person may have a sensation of heaviness or numbness in the arm.
- There may be a pulsating lump just above the clavicle, if there is arterial pressure.
- The affected person may experience a deep-seated pain in the neck and shoulder region. This pain may increase in intensity at night.
- The person may get easily fatigued, especially when using his arms.
- A superficial vein distension may occur in the hand.
- There may be paresthesia along the inner side of the forearm and the palm.
- If there is nerve compression, then the person may experience muscle weakness, which could progress to atrophy of the muscles that help to hold objects (long finger flexors) and the small muscles of the hand.
- The person may complain of difficulty with fine motor tasks of the hand.
- The affected person may experience cramps on the inner forearm.
- A sensation of tingling and numbness in the areas such as neck, shoulder, arm, hands, etc., may occur.
Diagnosis of the Syndrome
- One of the simple test available is Adson’s sign. This is one of the most common tests to reach a temporary diagnosis, besides the analysis of the symptoms. In this test, the affected individual is asked to turn his head to one side during deep inspiration. The loss of radial pulse in the arm is considered to be an indicator of the syndrome. However, this alone cannot be used as a diagnostic test for the treatment of the condition, as even people who are not susceptible to the syndrome may test positive.
- The costoclavicular maneuver is another test that helps reach an initial diagnosis of the syndrome. In this test, the person is asked to stand in a relaxed posture, with the head facing forward. The person needs to depress and retract the shoulders, extend the humerus and abduct it at an angle of thirty degrees, while hyperextending the neck and the head. However, this test is also used to diagnose costoclavicular syndrome.
- When the person is made to raise both hands above the head, the affected arm will be paler than normal due to compromised blood supply to the arm.
- In a compression test, pressure would be felt between the clavicle and the medial humeral head, which in turn might cause pain and numbness to radiate to the affected arm.
- The aforementioned tests alone are not sufficient to reach a diagnosis. It is best to get an arteriography done, if a surgery has been recommended to correct the syndrome, due to pressure on an artery.
The treatment for this condition will depend on the underlying anomaly, that is, compression of nerves or vessels, which are causing the aforementioned symptoms.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.