Thoreacic Outlet Syndrome Research Paper
Thoracic Outlet Syndrome is a complex disorder characterized by a constellation of signs and symptoms resulting from a compression of blood vessels and nerves in the thoracic outlet region where they exit the chest. The thoracic outlet is a space located between the thorax (rib cage) and the clavicle (collarbone) which contains major blood vessels and nerves. The thoracic outlet is the area through which nerves and blood vessels travel to and from the arm. Thoracic Outlet syndrome is considered a “syndrome” since it involves multiple systems, including neural complexes, vascular structures, and musculoskeletal systems. This paper will analyze, discuss, and inform you on what Thoracic Outlet Syndrome is; parts of the body that are affected
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by the disorder, and how to prevent the disorder in certain work environments.
In general, the cause of thoracic outlet syndrome is compression of the nerves or blood vessels in the thoracic outlet just under your collarbone and before the first rib.
The area between these two bones serves as a passage way for the subclavian artery, the subclavian vein, and the neurovascular bundle made of the brachial plexus and some smaller nerves (Surg 28). The cause of the compression varies and can include: anatomical defects, these defects are inherited defects that are present at birth may include an extra rib located above the first rib or an abnormally tight fibrous band connecting your spine to your rib. Another cause is poor postures which consist of drooping your shoulders or holding your head in a forward position can cause compression in the thoracic outlet area. Thirdly, a traumatic event, such as a car accident, can cause internal changes that then compress the nerves in the thoracic outlet. The onset of symptoms related to a traumatic accident often is delayed. And lastly, repetitive activities, over time, wear on your body’s tissue. Several occupations have been associated with TOS such as dry wall hanger or plasterer, welder, beautician, assembly line inspector, dental hygienist and a host of …show more content…
others.
Thoracic outlet syndrome symptoms can vary, depending on which structures are compressed.
The most common type of thoracic outlet is neurogenic TOS where the brachial plexus is compressed. Some estimates 95% of all TOS are neurological in nature (Surg 28). Many of the symptoms of neurogenic TOS are similar to other nerve related repetitive stress injuries where swelling or inflammation presses on the nerve. This can send shooting pains or radiate aching throughout the affected area. When nerves are compressed, signs and symptoms of neurological thoracic outlet syndrome include; Wasting in the fleshy base of your thumb (Gilliatt- Sumer Hands); Numbness or tingling in your arm or fingers; pain or aches in your neck, shoulder or hand; and a weakening grip (Surg 29).
In Vascular TOS where either the subclavian artery or the subclavian vein are compressed symptoms are consistent with reduced blood flow such as, throbbing lump near collarbone, a blood clot under your collarbone, or a weak pulse in your arm (Watson 6). Restriction of the subclavian vein on the return side can lead to a buildup of oxygen depleted blood resulting in a blush discoloration. It can also show itself in the form of pain and swelling, as blood pressure increases from a normal supply and a reduced ability to return it to the heart causing a backup of blood in the
arm.
You may notice symptoms of thoracic outlet syndrome if your job requires you to repeat a movement continuously, such as typing on a computer, working on an assembly line or lifting things above your head, as if you were stocking shelves. These types of job duties can be very serious to your long term health. Thoracic outlet syndrome is also a common disorder to athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movement. Pressure on your joints such as, obesity can put an undue amount of stress on your joints, as can carrying around an oversized bad or backpack. Pregnant women need to be aware as well because joints loosen during pregnancy as may have some effect on the TOS area.
In conclusion, it is very difficult to prevent TOS if your job requires you to stock shelves, speed typing, throw fast balls, or swim thousands of miles preparing for the Olympics. Some physicians recommend you to take frequent breaks when you feel a slight bit of tension. Rotate your shoulder forwards and backward to loosen up. Make sure you stretch before and after if you’re an athlete. If you’re obese try shedding some pounds to take the pressure off. These exercises may sound simple but prevent protects you from treatment. There are various treatments that can be utilized for a patient with TOS, and most benefit from a combination of medications in conjunction with physical and occupational therapy (Watson 10). Usually, a physical therapy regimen begins with patient education. Therapists work with the patients to correct workspace and home ergonomics. Improved posture during sitting, standing, and sleeping often reduces edema and tension, and thus ameliorates symptoms. The other more costly treatment is surgery. Surgical treatment for TOS has been described in narrative reviews, case reports, and retrospective case ( Crosby 43-49) Surgery should include exploration of the brachial plexus throughout its course in the thoracic outlet in order to decompress it by resecting any compressive and/or constrictive structures. These may include any of the three sites of compression mentioned earlier. No specific method of surgical treatment has been proven to be most effective. Surgical treatment should only be considered if; the patient has met the diagnostic criteria, the condition interferes with work or activities of daily living, and the condition does not improve despite conservative treatment.
References
Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Am J Surg. 1976;132:771–8. [PubMed]
Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome part 1: Clinical manifestations, differentiation and treatment pathways. Man Ther. 2009;14:586–95. [PubMed]
Crosby CA, Wehbe MA. Conservative treatment for thoracic outlet syndrome. Hand Clin
2004;20:43-49. Narrative Review
by the disorder, and how to prevent the disorder in certain work environments.
In general, the cause of thoracic outlet syndrome is compression of the nerves or blood vessels in the thoracic outlet just under your collarbone and before the first rib.
The area between these two bones serves as a passage way for the subclavian artery, the subclavian vein, and the neurovascular bundle made of the brachial plexus and some smaller nerves (Surg 28). The cause of the compression varies and can include: anatomical defects, these defects are inherited defects that are present at birth may include an extra rib located above the first rib or an abnormally tight fibrous band connecting your spine to your rib. Another cause is poor postures which consist of drooping your shoulders or holding your head in a forward position can cause compression in the thoracic outlet area. Thirdly, a traumatic event, such as a car accident, can cause internal changes that then compress the nerves in the thoracic outlet. The onset of symptoms related to a traumatic accident often is delayed. And lastly, repetitive activities, over time, wear on your body’s tissue. Several occupations have been associated with TOS such as dry wall hanger or plasterer, welder, beautician, assembly line inspector, dental hygienist and a host of …show more content…
others.
Thoracic outlet syndrome symptoms can vary, depending on which structures are compressed.
The most common type of thoracic outlet is neurogenic TOS where the brachial plexus is compressed. Some estimates 95% of all TOS are neurological in nature (Surg 28). Many of the symptoms of neurogenic TOS are similar to other nerve related repetitive stress injuries where swelling or inflammation presses on the nerve. This can send shooting pains or radiate aching throughout the affected area. When nerves are compressed, signs and symptoms of neurological thoracic outlet syndrome include; Wasting in the fleshy base of your thumb (Gilliatt- Sumer Hands); Numbness or tingling in your arm or fingers; pain or aches in your neck, shoulder or hand; and a weakening grip (Surg 29).
In Vascular TOS where either the subclavian artery or the subclavian vein are compressed symptoms are consistent with reduced blood flow such as, throbbing lump near collarbone, a blood clot under your collarbone, or a weak pulse in your arm (Watson 6). Restriction of the subclavian vein on the return side can lead to a buildup of oxygen depleted blood resulting in a blush discoloration. It can also show itself in the form of pain and swelling, as blood pressure increases from a normal supply and a reduced ability to return it to the heart causing a backup of blood in the
arm.
You may notice symptoms of thoracic outlet syndrome if your job requires you to repeat a movement continuously, such as typing on a computer, working on an assembly line or lifting things above your head, as if you were stocking shelves. These types of job duties can be very serious to your long term health. Thoracic outlet syndrome is also a common disorder to athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movement. Pressure on your joints such as, obesity can put an undue amount of stress on your joints, as can carrying around an oversized bad or backpack. Pregnant women need to be aware as well because joints loosen during pregnancy as may have some effect on the TOS area.
In conclusion, it is very difficult to prevent TOS if your job requires you to stock shelves, speed typing, throw fast balls, or swim thousands of miles preparing for the Olympics. Some physicians recommend you to take frequent breaks when you feel a slight bit of tension. Rotate your shoulder forwards and backward to loosen up. Make sure you stretch before and after if you’re an athlete. If you’re obese try shedding some pounds to take the pressure off. These exercises may sound simple but prevent protects you from treatment. There are various treatments that can be utilized for a patient with TOS, and most benefit from a combination of medications in conjunction with physical and occupational therapy (Watson 10). Usually, a physical therapy regimen begins with patient education. Therapists work with the patients to correct workspace and home ergonomics. Improved posture during sitting, standing, and sleeping often reduces edema and tension, and thus ameliorates symptoms. The other more costly treatment is surgery. Surgical treatment for TOS has been described in narrative reviews, case reports, and retrospective case ( Crosby 43-49) Surgery should include exploration of the brachial plexus throughout its course in the thoracic outlet in order to decompress it by resecting any compressive and/or constrictive structures. These may include any of the three sites of compression mentioned earlier. No specific method of surgical treatment has been proven to be most effective. Surgical treatment should only be considered if; the patient has met the diagnostic criteria, the condition interferes with work or activities of daily living, and the condition does not improve despite conservative treatment.
References
Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Am J Surg. 1976;132:771–8. [PubMed]
Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome part 1: Clinical manifestations, differentiation and treatment pathways. Man Ther. 2009;14:586–95. [PubMed]
Crosby CA, Wehbe MA. Conservative treatment for thoracic outlet syndrome. Hand Clin
2004;20:43-49. Narrative Review