| Thoracic outlet syndrome cannot be described as | | | | pain during their stroke and this should raise the |
| one condition but is the agreed name for a variety of | | | | suspicion of thoracic outlet problems. Repetitive |
| symptoms which are explained by being assumed to | | | | shoulder movements towards the end of the |
| be due to compression of the blood vessels and | | | | available movement make this more likely to occur in |
| nerves as they go through the area called the | | | | many sports or activities. Symptoms may present as |
| thoracic outlet. The outlet is made up of a triangle | | | | neurological difficulties or as problems connected with |
| the boundaries of which are the scalene muscles, the | | | | blood supply to the arm. |
| first rib and the collar bone or clavicle, through which | | | | Thoracic outlet syndrome presents differently due to |
| the nerves and vessels go to get to the axilla and | | | | whether the compressed structures are the blood |
| then to the arm. Patient diagnosis is very difficult in | | | | vessels, the nerves or both together. The level of |
| this field and little agreement exists about the | | | | pain and disability involved can vary from mild to |
| condition. | | | | severe, with symptoms continuous or intermittent. |
| People with thoracic outlet syndrome show such | | | | The normal presentation groups are one whose |
| wide variation in their symptoms and their signs and | | | | symptoms are not clear or specific, the vascular |
| there is no clear follow up test to substantiate the | | | | group and the neurological group. Compression of the |
| diagnosis. This ensures diagnosis of this condition | | | | main vein or artery in the arm does not occur |
| correctly is problematic and unclear. How many | | | | commonly and perhaps most often in young athletes |
| people suffer from this syndrome is consequently | | | | who perform excessive overhead throwing. |
| not certain although higher numbers of female | | | | If the arterial flow is disrupted the arm can change |
| patients present with poor posture and poor | | | | colour, there can be pain on muscle use due to their |
| development of thoracic and shoulder muscles. | | | | not getting enough blood and an overall pain in the |
| The neurovascular bundle, the rope of nerves and | | | | hand and the arm. Mild onset is typical as blood can |
| blood vessels, travels from the neck on its way to | | | | often get round a blockage, but when the block is |
| supply the arm and goes across three small spaces | | | | large patients attend for medical review |
| roughly triangular in shape. Any of these small spaces | | | | independently. Thoracic outlet syndrome from |
| can contribute to compression problems and the | | | | neurological compression involves compression of |
| spaces are small as the arm is rested by the side, | | | | some of the brachial plexus, a nerve crossroads in |
| narrowing even further if the arm is moved into | | | | the neck which supplies the arms. Nerve compression |
| certain postures. The positions which increase the | | | | does not usually occur alone but presents with |
| tightness of the spaces are used as tests, as testing | | | | awkwardness holding a ball or a racket and loss of |
| can indicate which structures are compressing and | | | | muscle bulk in the small hand muscles. |
| which being compressed. Physiotherapy and medical | | | | Compression of nerve structures can present with |
| testing involves placement of the patient's arm in a | | | | loss of feeling and pins and needles, with pain |
| stressful posture and then to ask them to do a | | | | reported at times but not a typical problem. |
| repeated action such as clenching and unclenching the | | | | Aggravating activities again are mostly in the realm of |
| fist. This causes an increased demand on the | | | | repeated overhead actions, usually in sports. The |
| neurological and vascular systems. | | | | third type of thoracic outlet syndrome is the more |
| The repetitive movement of the shoulder towards | | | | difficult group as a large number of patients present |
| the ends of its ranges makes the onset of thoracic | | | | with pain in the arm, neck and shoulder blade regions. |
| outlet syndrome more likely, increasingly so if | | | | A traumatic onset from an incident of some kind is |
| shoulder abduction (moving the arm out to the side) | | | | typical and the meaning of these symptoms is not |
| and outward rotation are involved at end ranges. A | | | | clear, with much disagreement as to whether these |
| common occurrence is for swimmers to complain of | | | | conditions are part of thoracic outlet syndrome. |