| Thoracic outlet syndrome cannot be described as | | | | for swimmers to complain of pain during their |
| one condition but is the agreed name for a | | | | stroke and this should raise the suspicion of |
| variety of symptoms which are explained by | | | | thoracic outlet problems. Repetitive shoulder |
| being assumed to be due to compression of the | | | | movements towards the end of the available |
| blood vessels and nerves as they go through the | | | | movement make this more likely to occur in |
| area called the thoracic outlet. The outlet is made | | | | many sports or activities. Symptoms may |
| up of a triangle the boundaries of which are the | | | | present as neurological difficulties or as problems |
| scalene muscles, the first rib and the collar bone | | | | connected with blood supply to the arm. |
| or clavicle, through which the nerves and vessels | | | | Thoracic outlet syndrome presents differently due |
| go to get to the axilla and then to the arm. | | | | to whether the compressed structures are the |
| Patient diagnosis is very difficult in this field and | | | | blood vessels, the nerves or both together. The |
| little agreement exists about the condition. | | | | level of pain and disability involved can vary from |
| The wide variation in signs and symptoms of | | | | mild to severe, with symptoms continuous or |
| sufferers with thoracic outlet syndrome and the | | | | intermittent. The normal presentation groups are |
| absence of any test to confirm or deny its | | | | one whose symptoms are not clear or specific, |
| presence means that correct diagnoses of | | | | the vascular group and the neurological group. |
| patients with thoracic outlet syndrome is difficult. | | | | Compression of the main vein or artery in the |
| The numbers of people who suffer from this | | | | arm does not occur commonly and perhaps most |
| syndrome is as a consequence not clear although | | | | often in young athletes who perform excessive |
| it is known that higher numbers of women occur | | | | overhead throwing. |
| in this group, especially if they have poor muscle | | | | If the arterial flow is disrupted the arm can |
| tone and posture. | | | | change colour, there can be pain on muscle use |
| The nerves and blood vessels travel in what is | | | | due to their not getting enough blood and an |
| termed a bundle, moving down from the cervical | | | | overall pain in the hand and the arm. Mild onset is |
| spine and towards the arm, going through three, | | | | typical as blood can often get round a blockage, |
| mostly triangular spaces, on the way. | | | | but when the block is large patients attend for |
| Compression of the bundle can occur in any of | | | | medical review independently. Thoracic outlet |
| the three triangles, which are already small when | | | | syndrome from neurological compression involves |
| the arm is by the side, reducing further in size as | | | | compression of some of the brachial plexus, a |
| the arm moves into certain postures. Postures | | | | nerve crossroads in the neck which supplies the |
| which increase the tightness of the spaces are | | | | arms. Nerve compression does not usually occur |
| used as diagnostic tests to figure out which | | | | alone but presents with awkwardness holding a |
| structures are causing the compression and which | | | | ball or a racket and loss of muscle bulk in the |
| are being compressed. Doctors and | | | | small hand muscles. |
| physiotherapists test by placing the limb of the | | | | Neurological compromise may also cause pins and |
| patient in a specific posture known to be stressful | | | | needles or loss of feeling, with some reports of |
| and asking them to perform a repeated muscle | | | | pain but this tends not to be a major issue. |
| action such as fist clenching. This heightens the | | | | Overhead actions with the arm repetitively tend |
| demand on the blood supply or neurological control | | | | again to be the aggravating factors. The third |
| required. | | | | group is the contentious one, with a large number |
| The repetitive movement of the shoulder | | | | of patients who complain of pain in the neck, |
| towards the ends of its ranges makes the onset | | | | shoulder blade and arm. Often starting after an |
| of thoracic outlet syndrome more likely, | | | | accident of some type, this kind of pain is not well |
| increasingly so if shoulder abduction (moving the | | | | understood and there is little medical agreement |
| arm out to the side) and outward rotation are | | | | as to whether this is thoracic outlet syndrome or |
| involved at end ranges. A common occurrence is | | | | not. |