THORACIC-OUTLET

General Information

DEFINITION--Pain and weakness from compression of nerves in the neck that affect the shoulders, arms and hands.

BODY PARTS INVOLVED--Nerves and blood vessels that supply the neck, shoulders, arms and hands.

SEX OR AGE MOST AFFECTED--Adults between ages 35 and 55, usually women.

SIGNS & SYMPTOMS

• Pain, numbness and tingling in the neck, shoulders, arms and hands.
• Weakness in the arms and hands.
• Poor blood circulation, characterized by coldness, swelling and blueness in the hands and fingers (rare).
• Absent pulse in the wrist when raising the arm and turning the head toward the opposite shoulder.

CAUSES--

The nerves and blood vessels that supply the shoulder, arms and hands start in the neck and pass as a bundle near the cervical ribs and collarbone. Pressure on this nerve and blood-vessel bundle creates symptoms. Pressure may be caused by:

• An extra rib in the lower neck or overdeveloped neck muscles.
• Muscle weakness and drooping in the shoulder.
• Injury from overextending the arm or shoulder.
• Tumor that has spread to the head and neck area from another part of the body.

RISK INCREASES WITH

• Fracture of clavicle or first rib.
• Body building with muscle bulk in thoracic outlet area.
• Rapid weight loss combined with vigorous physical exertion or exercise.

HOW TO PREVENT

• Avoid shoulder and neck injury whenever possible. Wear seat belts and use padded headrests in cars.
• Don't use mind-altering drugs or drink excessive amounts of alcohol.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• X-ray, arteriogram (See Glossary), venogram (x-ray of a vein filled with contrast medium) and CT scan (See Glossary).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Treatment usually involves physical therapy and exercises unless there is an obvious bony abnormality.
• Surgery to relieve pressure on the nerves and blood vessels.

POSSIBLE COMPLICATIONS

• Postoperative pain or abnormal sensation in arm and hand.
• Recurrence of the disorder.

PROBABLE OUTCOME--Usually curable in most patients with physical therapy or surgery.

How To Treat

GENERAL MEASURES----Use heat to relieve pain. Use a heating pad, heat lamp, hot showers or warm compresses.

MEDICATION--

• You may use non-prescription drugs, such as acetaminophen or aspirin, to relieve pain. Medication cannot correct the underlying condition.
• Your doctor may prescribe antispasmodics and muscle relaxants.

ACTIVITY--

• Physical therapy and exercises will be prescribed to promote shoulder muscle function and improve any posture faults. These are usually recommended for 2 to 3 months.
• Avoid straining or heavy activity for 3 months.

DIET--No special diet. If overweight, a weight-reducing diet is recommended.

Call Your Doctor If

• You have symptoms of thoracic-outlet obstruction syndrome.
• Symptoms don't improve in 2 weeks, despite treatment.