Pain, tingling, muscle weakness in the arm, hand, shoulder or neck can be a sign of thoraco-brachial outlet syndrome. Medical imaging exams and an electromyogram can highlight it. The sooner the diagnosis is made, the sooner treatments are undertaken, and the better the recovery. Find out what this syndrome is, what its symptoms are, its diagnosis and treatments.
Definition of thoraco-brachial outlet syndrome
Thoraco-brachial outlet syndrome is a pathology caused by a conflict between several structures, resulting in intermittent or permanent compression of nerves or blood vessels (veins, arteries). This compression takes place between the neck and the thorax, specifies the MSD Manual. And more precisely, between the collarbone and the first rib. According to the Canadian Center for Occupational Health and Safetywe distinguish :
- Vascular thoraco-brachial outlet syndrome, caused by compression of veins, and more rarely arteries, between the neck and the thorax.
- Neurological thoraco-brachial outlet syndrome, due to the compression of nerves coming from the spinal cord, which control the movements of the arm, shoulder and hand. It represents more than 90% of cases, according to the Swiss Medical Review.
- Non-specific thoraco-brachial outlet syndrome: clinical signs of thoraco-brachial outlet syndrome are present and worsened with exercise, but no origin is identified.
This syndrome can be caused by trauma (accident), obesity, pregnancy, an anatomical anomaly, or the adoption of poor postures or certain professional practices (carrying loads, raising the arms, etc.).
Symptoms of thoraco-brachial outlet syndrome
The symptoms of thoraco-brachial outlet syndrome vary depending on the location of the compression and its nature (vascular or nervous).
In the case of nerve compression, the symptoms are:
- numbness and tingling in the arms or fingers (paresthesias);
- pain in the hand, shoulder or neck;
- weakness when gripping or extending fingers (dropping objects);
- atrophy of the muscle located at the base of the thumb, in some cases.
In the case of compression of the blood vessels, according to the Lyon University Hospital, the symptoms are:
Diagnosis of thoraco-brachial outlet syndrome
There is no specific examination to demonstrate thoraco-brachial outlet syndrome. Several examinations are necessary, the results of which can point towards the diagnosis of thoraco-brachial outlet syndrome. This involves carrying out medical imaging examinations. This involves a cervical x-ray, a Doppler ultrasound of the upper limbs, a cervical-arm-thorax scanner, or even an MRI of the cervical spine and/or brachial plexus. The diagnosis is also based on the result of the electromyogram. The electromyogram of the upper limbs records the electrical activity of the nerves and muscles of the arm. This examination therefore highlights possible nerve compression. Maneuvering tests, such as the candlestick test, can complete the diagnosis.
Treatments for thoraco-brachial outlet syndrome
Treatments for thoraco-brachial outlet syndrome are both physiotherapy and medication. In rare cases, surgery is necessary.
- Physiotherapy: initially, through massages, the physiotherapist relieves pain due to muscle contractions. Once this analgesic effect is obtained, over the long term (3 to 6 months), the physiotherapist works to improve the person’s posture through muscle strengthening exercises. The back muscles and trapezius muscles are mainly targeted by this need for strengthening.
- Medications: anti-inflammatories, muscle relaxants (muscle relaxants) may be prescribed to relieve pain. Injections of botulinum toxin into the place of compression can also be considered.
- Surgical intervention: rarely performed, it only occurs as a last resort, after the failure of physiotherapy and medications to relieve the person, informs the Lyon University Hospital. This involves vascular or nerve decompression surgery, preferably via the axillary route, or via the supra- and subclavian route, if necessary.
Sources
- Cervico thoraco brachial outlet syndrome (Sd DCTB)Civil Hospices of Lyon, September 16, 2022
- Thoracic outlet syndromesThe MSD Manual – Consumer Version, April 2022
- Symptoms of thoracic outlet syndromeThe MSD Manual – Healthcare Professional Version, April 2022
- Thoraco-brachial outlet syndromeCanadian Center for Occupational Health and Safety, October 31, 2023
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