Thoracic Outlet Syndrome
Thoracic outlet is an anatomical space between the collar bone& 1st rib, through which the nerve artery & vain comes out. So if any of these strictures got compressed by 1st rib & collar bone or compressed by pectoral muscle & rib or by the scalene muscles, can create -tingling, numbness, weakness in the arm. Some time it can be happened by the compression of an extra cervical rib. It could be in both sides.
There are two reasons for Thoracic Outlet Syndrome (TOS):-1st If there is some history of trauma or accident which creates spasm of the muscle. 2nd It can be through occupational hazards like;-repetitive work, such as computer programmer, mechanics. Some time it also found to the athletes but generally they have arterial/venous thoracic outlet syndrome.
Thoracic Outlet Syndrome (TOS) is bit difficult to diagnose, and often misdiagnose with cervical spondylosis or Carpal Tunnel Syndrome or Cubital Tunnel Syndrome .Sometimes it took years to diagnose through x-ray or MRI because the reports are coming normal. Nerves are not damage, it just got compressed. Good history & physical exam, ability to feel the Scalene muscle in the neck which will be tender & inability to do task in over head position is the indicator for Thoracic Outlet Syndrome (TOS).
There are three types of Thoracic Outlet Syndrome (TOS):-
- Neurogenic Thoracic Outlet Syndrome.
- Venous Thoracic Outlet Syndrome.
- Arterial Thoracic Outlet Syndrome.
What treatment options are there?
For Neurogenic Thoracic Outlet Syndrome:-Physical Therapy/Physiotherapy ,Ergonomic correction of the work place do significant improvement.60% to 70% patient got better through Physical Therapy/Physiotherapy, it took few weeks to get better & live a healthy pain free life.
Venous thoracic outlet syndrome: – It is more acute, if there is any cervical rib, it should be removed. But surgery should be the last option .Through Manual therapy techniques it can be avoidable.
Arterial thoracic outlet syndrome: – If there is some arterial clot, it needs intervention quickly (Blood thinner helps). Through Manual therapy techniques it can be avoidable.