Thoracic outlet syndrome surgery pictures

What is a thoracic outlet syndrome?

It is a group of disorder that takes place when the nerves or blood vessels in the space between the first rib and collarbone are compressed. ^{(1, 2)}

picture 1: An image showing the thoracic outlet anatomy, which basically involves the muscles and nerves around the shoulder area.

image source: tos.wustl.edu

Thoracic outlet syndrome causes

• Severe physical trauma such as car accident
• Repetitive injury
• Pregnancy ⁽³⁾
• Anatomical defect
• Poor posture
• Pressure on the joints

picture 2: An image showing the cardinal signs and symptoms of thoracic outlet syndrome.

Photo source: i.ytimg.com

Thoracic outlet syndrome symptoms

• Weakening grip
• Pain in the neck, shoulder, and hand area
• Tingling or numbness sensation in the arms and/or fingers
• Discoloration of the extremities
• Cold and clammy hands and/or fingers
• The arm gets easily tired with activity
• A painful lump near the collarbone ^{(4, 5)}

Thoracic outlet syndrome diagnosis

It can be difficult to diagnose thoracic outlet syndrome because the symptoms vary from one person to another. To accurately diagnose the condition, the doctor will thoroughly check the condition of the patient including the past medical and surgical history. Other thoracic outlet syndrome tests include the following:

• Provocation Test

To determine the cause of the condition and rule out other similar symptoms.

• X-ray

This is done to check an extra rib (cervical rib) and to rule out other conditions. ⁽⁴⁾

picture 3: An x-ray film of a patient with thoracic outlet syndrome.

image source: med.nyu.edu

• Ultrasound

This is done to check if you have vascular thoracic syndrome and other related problems.

picture 4: An ultrasound image of a patient with thoracic outlet syndrome.

photo source: www.internationalshoulderjournal.org

• CT scan

It obtains the cross-sectional images of the body to identify the location and cause of blood vessel compression. ⁽⁵⁾

• MRI

To determine the exact location and cause of blood vessel compression and check congenital anomalies.

• Angiography

To make blood vessels visible. ⁽⁶⁾

picture 5: An angiogram of the arm was performed to check the artery at the thoracic outlet level.

image source: thoracickey.com

• Arteriography and venography

A catheter is inserted through a small incision to show an x-ray images of the arteries and veins.

• EMG

It is done to check the electrical activity of the muscles as they contract and rest.

• Nerve conduction study

It is done to test and measure the ability of the nerve to send impulses to muscles in various areas of the body. ^{(5, 6, and 7)}

Thoracic outlet syndrome treatment

• Physical therapy

It is helpful in patients with neurogenic thoracic outlet syndrome. It strengthens and stretches the affected muscles, improve posture, and improve range of motion.

• Medicines

The doctor will prescribe pain reliever and anti-inflammatory drugs to reduce the pain and inflammation. The doctor might also prescribe muscle relaxants and blood dissolving drugs.

• Surgery

If other treatment methods fail, the last resort would be surgery. The surgery is called thoracic outlet decompression that can be done using various methods such as trans-axillary approach, supraclavicular approach, and infraclavicular approach. ^{(5, 7, and 8)}

picture 6: A patient who has underwent a thoracic outlet syndrome surgery.

picture source: www.thestudentphysicaltherapist.com

picture 7: Thoracic outlet syndrome surgery via the supraclavicular approach.

image source: accesssurgery.mhmedical.com

picture 8: Thoracic outlet syndrome surgery via the trans-axillary approach.

photo source: i.ytimg.com

What are the possible complications?

If the condition is not treated the earliest time possible, the patient could suffer from progressive nerve damage, which will require surgical intervention. Surgery has a higher risk than other treatment methods and so it should be performed only when deemed necessary. ^{(2, 4, and 5)}

How to prevent thoracic outlet syndrome?

• If you are at risk for thoracic outlet compression, you should avoid doing repetitive movements.
• Avoid lifting heavy objects.
• You should maintain a healthy weight.
• Avoid carrying heavy bag over your shoulder as it increases the pressure on the thoracic outlet.
• Exercise regularly. There are thoracic outlet syndrome exercises that can keep the shoulder muscles strong. ^{(1, 7, and 8)}

picture 9: Recommended exercises for patients with thoracic outlet syndrome.

image source: myhealth.alberta.ca

References

1. https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
2. https://www.medicinenet.com/thoracic_outlet_syndrome/article.htm
3. https://en.wikipedia.org/wiki/Thoracic_outlet_syndrome
4. https://my.clevelandclinic.org/health/articles/thoracic-outlet-syndrome
5. https://emedicine.medscape.com/article/96412-overview
6. https://www.healthline.com/health/thoracic-outlet-syndrome
7. https://vascular.org/patient-resources/vascular-conditions/thoracic-outlet-syndrome
8. http://physioworks.com.au/injuries-conditions-1/thoracic-outlet-syndrome