The arteries, veins and nerves of the arms leave the chest cavity between the collarbone and the first rib. This syndrome develops due to compression of vessels or nerves between these two bones.
95% of this syndrome is caused by nerves, and 5% is caused by vascular compression. 2% of vascular compression occurs due to artery compression and 3% due to vein compression. 60% of the cases are seen bilaterally.
This syndrome is generally seen in 5-8% of the society, being more common in women over the age of 35. The most important reason for this is due to the weakness in the muscle structure in women and the breasts pulling down.
The causes of thoracic outlet syndrome;
- The bone and band that congenitally compress this area. or muscle structures
- Traumas to this area
- People who work with their arms up for a long time (volleyball players, teachers, etc.)
- People who work in a forward-leaning position for a long time
- Sports that cause chronic trauma (swimming, tennis and wrestling, etc.)
- People who carry backpacks for a long time
- Violin players
- Those with poor posture in patients
- Heavy exercises that cause excessive growth in neck muscles
CLINIC
Due to nerve compression in patients ,
-Pain develops in the arm, shoulder and anterior chest wall.
-Pain develops in the arm and especially in the 3rd-4th. Numbness develops in the and 5th fingers.
-In advanced chronic cases, weakening of the arm muscles is observed.
-Patients often develop intolerance to tasks that require lifting the arms up (laying out laundry, etc.).
In patients with artery compression
-Coldness, paleness and pain are observed in the hands. Sometimes ulcerated wounds develop on the fingertips. Tolerance to cold weather is impaired.
In patients with compressed veins
-Edema develops in the arms and fingers.
DIAGNOSIS
-Direct neck radiography: The presence of congenital excess bone is investigated.
-MRI: Bands or similar structures in the transition areas of vessels and nerves are investigated.
-Doppler. ultrasound: narrow veins disorders are observed
-Angiography: arteries are evaluated
-Venography: veins are evaluated.
-EMG: nerve pressure is evaluated (Ulnar nerve conduction velocity is measured)
TREATMENT
-Conservative treatment
-Surgical treatment
With conservative treatments 1 The aim is to increase the distance between the ribs and the collarbone.
In this, first of all, it must be ensured that the body remains straight. Exercises that will strengthen the shoulder muscles and loosen the neck muscles are provided.
Surgical treatment can be applied to patients who do not benefit from conservative treatment and have many complaints.
In surgical treatment, a 5-6cm incision is made under the armpit. By removing the first admittance, the gap through which the nerves and vessels pass is widened.
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