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Thoracic Outlet Syndrome

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Thoracic outlet syndrome includes a variety of conditions that compress the blood vessels or nerves in the space between the collarbone and first rib, which is known as the thoracic outlet.

Neurogenic Thoracic Outlet Syndrome
The most common type of thoracic outlet syndrome, this condition occurs when the brachial plexus is compressed. The brachial plexus is a group of nerves that run from the spinal cord and control muscles and sensations in the shoulder, arm, and hand.

Vascular Thoracic Outlet Syndrome
This condition occurs when one or more of the veins or arteries located under the collarbone are compressed.

Nonspecific-Type Thoracic Outlet Syndrome
Also known as disputed thoracic outlet syndrome, this condition is characterized by chronic (long-lasting) pain in the chest area that tends to worsen with activity – but the cause of pain can’t be determined.

Risk Factors

Thoracic outlet syndrome usually affects people between 20 and 40. Risk factors include:

  • Birth disorders, such as an extra rib or an unusually tight, fibrous band that connects your spine to your rib
  • Being female
  • Poor posture
  • Pregnancy
  • Repetitive activity, such as baseball, basketball,volleyball, typing on a computer, working on an assembly line, or lifting items above your head
  • Traumatic injury

Symptoms

The symptoms of thoracic outlet syndrome may include:

  • Blood clot in upper body veins or arteries
  • Bluish discoloration of your hand
  • Coldness in fingers, hands, or arms
  • Numbness or tingling in your arms or fingers
  • Pain and swelling in the arm
  • Pain in your neck, shoulder, or hand
  • Pallor (lack of color) in one or more fingers
  • Throbbing lump near the collarbone
  • Weak grip
  • Weak or no pulse in one arm
  • Weakness of your arm or neck

At the University of Miami Health System, our experts provide the latest in treatment options for thoracic outlet syndrome, which may include physical therapy or surgery.


Tests

Duplex Ultrasound
A duplex ultrasound test uses sound waves to assess your blood flow and structure of the veins.

Magnetic resonance angiography (MRA)
This procedure uses a combination of magnetic resonance (MRI) technology and contrast dye injected through an IV for your doctor to obtain a clear image of how your blood vessels are functioning.

Angiogram
An angiogram of the renal arteries are scans using contrast injected into a blood vessel. They show how and where your blood flows.

Nerve Conduction Study
This test is typically used to evaluate the function of the motor and sensory nerves of your body.


Treatments

Physical Therapy
If you have neurogenic thoracic outlet syndrome, your doctor may recommend you undergo regular physical therapy. Working with a specially trained therapist, you will learn exercises that strengthen and stretch your shoulder muscles to help open up the thoracic outlet, improve range of motion, and improve posture. Over time, performing these exercises regularly may help relieve pressure from your blood vessels and nerves in the thoracic outlet.

Medications
Certain medications – such as anti-inflammatory medicine, pain medicine, or muscle relaxants –can be used to decrease inflammation, reduce pain, and relax muscles.

Clot-Busting Medications
If you have vascular thoracic outlet syndrome that has caused blood clots, your doctor may administer clot-busting medications (thrombolytics) directly into your veins or arteries to help break up the clots. After this, you may take a regular regimen of clot-preventing medication (anticoagulants).

Thoracic Outlet Decompression
If more conservative treatment options haven’t been effective for neurogenic thoracic outlet syndrome or if you have evidence of vascular thoracic outlet syndrome, your doctor may recommend you undergo surgery to relieve symptoms and complications related to thoracic outlet syndrome. There are several types of thoracic outlet decompression, but they all involve decreasing pressure on the nerves or blood vessels affected by the condition. It typically requires excision of the 1st thoracic rib and the anterior scalene muscle.

Our group of vascular and thoracic surgeons are experts on all surgical approaches for thoracic outlet decompression and they would select the best approach for your particular case:

Supraclavicular approach: Recommended for arterial thoracic outlet syndrome that may require arterial reconstruction.

Transaxillary approach: Recommended for venous thoracic outlet syndrome if strong desire to avoid possible intercostal pain and chest tubes associated with the robotic approach

Robotic-assisted thoracoscopic surgery: Associated with better visualization of the entire 1st rib and thoracic outlet structures which could potentially represent lower risk of recurrence. This is a relatively new technique that may become the preferred approach for thoracic outlet decompression in the near future. Our thoracic surgeons are expert robotic surgeons.


Why Choose UHealth?

Leading-edge imaging care in South Florida. Our doctors are also researchers discovering new ways to improve diagnosis and treatment. That means you can get some of today’s most promising advancements through clinical trials. You benefit from the latest developments that are fast-tracked from the lab to the bedside.

Advanced, hard-to-find procedures. Our doctors are committed to delivering the very best care. That’s why they offer the latest treatments – including limb salvage, endovascular grafting, and thoracic outlet decompression – to improve blood flow.

All the care you need, from one doctor. Our vascular surgeons perform a wide range of procedures. That means you can have the same doctor for any vascular care you need as your condition changes. Whether you need a stent replaced or a vein grafted, you can always turn to the doctor you trust.

Experienced doctors, reliable results. UHealth vascular surgeons perform hundreds of stent placements, angiograms, and more every year. You can be confident you’re receiving the very best care from a doctor with advanced experience.

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