Thoracic Outlet Syndrome in Dubai

Thoracic Outlet Syndrome (TOS) is a condition that involves compression of the nerves or blood vessels in the thoracic outlet, the space between your collarbone (clavicle) and your first rib. This compression can lead to pain, numbness, tingling, and weakness in the neck, shoulder, arm, and hand. Understanding the causes, symptoms, and treatment options for TOS can help individuals manage this condition more effectively.

Causes of Thoracic Outlet Syndrome

TOS can be caused by several factors that compress the nerves or blood vessels in the thoracic outlet. Some common causes include:

1. Anatomical Variations: Certain anatomical features, such as an extra rib (cervical rib) or an abnormally tight fibrous band connecting the spine to the rib (scalene muscle), can contribute to TOS.
2. Poor Posture: Slouching or holding the shoulders in a forward position for long periods can compress the thoracic outlet and lead to TOS.
3. Trauma: Injuries, such as whiplash or repetitive strain injuries, can damage the structures in the thoracic outlet and result in TOS.
4. Repetitive Movements: Activities that require repetitive movements of the arms and shoulders, such as typing or lifting heavy objects, can increase the risk of developing TOS.
5. Muscle Tightness: Tightness or spasm of the muscles in the neck and shoulder region can compress the thoracic outlet and lead to TOS.

Symptoms of Thoracic Outlet Syndrome

The symptoms of TOS can vary depending on which structures are compressed. Common symptoms include:

• Pain or aching in the neck, shoulder, arm, or hand
• Numbness or tingling in the fingers or hand
• Weakness or fatigue in the arm or hand
• Coldness or discoloration of the hand or fingers
• Swelling or puffiness in the arm or hand

Diagnosis of Thoracic Outlet Syndrome

Diagnosing Thoracic Outlet Syndrome (TOS) can be challenging due to the variety of symptoms and potential causes. A comprehensive approach is typically used, which may include the following steps:

1. Medical History: Your doctor will begin by asking about your symptoms, medical history, and any factors that may contribute to TOS, such as recent injuries or repetitive activities.
2. Physical Examination: A thorough physical examination will be conducted to assess your neck, shoulders, arms, and hands for signs of TOS, such as muscle weakness, tenderness, or swelling.
3. Provocative Tests: Specific tests, such as the Adson's maneuver, Roos test (elevated arm stress test), or Wright test, may be performed to reproduce symptoms and help diagnose TOS.
4. Imaging Studies: X-rays, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans may be ordered to rule out other conditions and to assess the structures in the thoracic outlet.
5. Nerve Conduction Studies: Electromyography (EMG) or nerve conduction studies may be performed to assess the function of the nerves in the affected area.
6. Vascular Studies: Doppler ultrasound or angiography may be used to evaluate blood flow and identify any vascular abnormalities in the thoracic outlet.
7. Other Tests: Additional tests, such as blood tests or nerve blocks, may be conducted to rule out other conditions or confirm the diagnosis of TOS.

Treatment of Thoracic Outlet Syndrome

Treatment for TOS aims to relieve compression of the nerves or blood vessels in the thoracic outlet and alleviate symptoms. Common treatment options include:

1. Physical Therapy: Exercises and stretches to improve posture, strengthen muscles, and relieve pressure on the thoracic outlet.
2. Medication: Pain relievers, muscle relaxants, or anti-inflammatory drugs to reduce pain and inflammation.
3. Surgery: In severe cases, surgery may be recommended to decompress the nerves or blood vessels in the thoracic outlet.
4. Lifestyle Modifications: Avoiding activities that worsen symptoms and maintaining good posture can help manage TOS.

Acquired Conditions Leading to Thoracic Outlet Syndrome

1. Poor Posture: Prolonged poor posture, such as slouching or holding the shoulders in a forward position, can contribute to TOS by compressing the nerves and blood vessels in the thoracic outlet.
2. Repetitive Movements: Jobs or activities that involve repetitive movements of the arms and shoulders, such as typing, lifting heavy objects, or playing certain sports, can increase the risk of developing TOS.
3. Trauma: Injuries, such as whiplash from car accidents or direct trauma to the shoulder or neck, can damage the structures in the thoracic outlet and lead to TOS.
4. Muscle Tightness or Imbalance: Tightness or imbalance of the muscles in the neck and shoulder region can compress the thoracic outlet and contribute to TOS.
5. Weight Gain: Excess weight, particularly in the upper body, can put pressure on the thoracic outlet and increase the risk of developing TOS.
6. Pregnancy: Changes in posture and increased weight during pregnancy can compress the thoracic outlet and lead to TOS in some women.
7. Occupational Factors: Jobs that require repetitive or prolonged overhead arm movements, such as assembly line work or painting, can increase the risk of TOS.

Thoracic Outlet Syndrome Special Tests

1. Adson's Test: This test is performed by having the patient rotate their head to the affected side and then extend their neck while taking a deep breath in and holding it. The radial pulse is then checked for any changes or loss of pulse, which could indicate compression of the subclavian artery.
2. Roos (Elevated Arm Stress) Test: In this test, the patient is asked to elevate their arms to 90 degrees, bend their elbows, and open and close their hands for 3 minutes. The test is positive if the patient experiences pain, numbness, tingling, or weakness in the arms or hands.
3. Wright Test: The Wright test involves abducting the arm to 90 degrees, externally rotating the shoulder, and extending the arm behind the body. The test is positive if the patient experiences symptoms such as pain, numbness, or tingling.
4. Costoclavicular Maneuver: This test is performed by having the patient retract their shoulders and push them downward while taking a deep breath in. A positive test is indicated by reproduction of symptoms or changes in pulse.
5. Hyperabduction Test: The hyperabduction test involves having the patient raise their arm overhead, which can compress the brachial plexus and subclavian artery. A positive test is indicated by reproduction of symptoms or changes in pulse.
6. Upper Limb Tension Test: This test is used to assess nerve tension in the upper limb. It involves positioning the arm in various ways to stretch the nerves and reproduce symptoms.

These tests are not always definitive and may need to be combined with other diagnostic methods, such as imaging studies or nerve conduction tests, to confirm a diagnosis of TOS. It is important for these tests to be performed by a healthcare professional trained in their administration to ensure accuracy and safety.

Surgical for Thoracic Outlet Syndrome

Surgery for Thoracic Outlet Syndrome (TOS) is considered when conservative treatments, such as physical therapy and medication, have not provided sufficient relief or if there is evidence of significant nerve or vascular compression. Surgical options for TOS aim to relieve compression of the nerves and blood vessels in the thoracic outlet and restore normal function. The type of surgery recommended depends on the underlying cause and severity of TOS. Here are some common surgical procedures for TOS:

1. First Rib Resection: This is the most common surgical procedure for TOS. It involves removing part or all of the first rib to relieve pressure on the nerves and blood vessels in the thoracic outlet. This procedure is often performed through a small incision in the armpit or the side of the neck.
2. Scalenectomy: In some cases, the scalene muscles (located in the neck) may be partially or completely removed to relieve compression on the nerves and blood vessels. This procedure is often performed in conjunction with first rib resection.
3. Pectoralis Minor Release: The pectoralis minor muscle, which lies underneath the pectoralis major muscle in the chest, may be released to relieve compression on the nerves and blood vessels.
4. Vascular Procedures: If there is significant compression of the subclavian artery, vascular procedures such as angioplasty (to widen the artery) or bypass surgery (to reroute blood flow) may be performed.
5. Nerve Decompression: In cases where nerve compression is the primary issue, surgical decompression of the affected nerves may be performed to relieve pressure and restore function.

Conclusion

Thoracic Outlet Syndrome can significantly impact an individual's quality of life, but with proper diagnosis and treatment, most people can find relief from their symptoms. If you are experiencing symptoms of TOS, it is essential to seek medical attention to determine the underlying cause and develop an appropriate treatment plan.

Post-Op Physical Therapy

If a patient does require surgery, then physical therapy should follow immediately to prevent scar tissue and return the patient to full function.

For top-notch thoracic surgery in Dubai, contact DRHC at +97142798200. We offer expert Thoracic surgeons and comprehensive care.