Case: 20-year-old bodybuilder
Reason for visit: 3 months of pain in both shoulders with pain radiating down his arms
After history and physical examination, he was determined to have bilateral neurogenic thoracic outlet syndrome.
What is thoracic outlet syndrome?
Thoracic outlet syndrome is a pattern of symptoms caused by compression of the neurovascular bundle at the thoracic outlet. The three areas where compression can occur are the scalene triangle, costoclavicular space, and the pectoralis minor space. Thoracic outlet syndrome can be further divided into arterial, venous, and neurogenic subtypes.
What are some risk factors of developing thoracic outlet syndrome?
Risk factors for thoracic outlet syndrome include anatomical variations such as a cervical rib, congenital cervical fibrocartiligenous bands, and muscular changes such as hypertrophy of the scalene, pectoralis or subclavis muscles. Injuries can also precipitate thoracic outlet syndrome as well. Whiplash, injuries from overhead work, throwing injuries, and falls can lead to thoracic outlet syndrome.
What are the symptoms of thoracic outlet syndrome?
Symptoms for thoracic outlet syndrome are dependent on which neurovascular structures are being compressed.
Arterial- compression of arteries can impair the flow of oxygenated blood to the affected limb leading to limb ischemia.
Venous- compression of veins can prevent blood from leaving the affected limb and lead to swelling of that arm.
Neurogenic- compression of the brachial plexus can lead to numbness and tingling of the arm on the affected side.
What is the management of thoracic outlet syndrome?
Thoracic outlet syndrome often requires imaging, vascular studies, and neurological studies such as an EMG to determine the location and magnitude of compression. Treatment can include soft tissue massages, physical therapy, activity modification, injections, and anticoagulation depending on what structures are compressed and the severity of symptoms. Surgery can be indicated in some cases.
Thoracic outlet syndrome can impair quality of life and limit daily activities. If you think you are suffering from thoracic outlet syndrome call Scottsdale Sports Medicine Institute to schedule an appointment with Dr David Carfagno.
Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation
Cheng, S. (1992). Thoracic Outlet Syndrome: A Common Sequela of Neck Injuries. Arch Surg Archives of Surgery, 488-488.
Sanders, R. (2013). Neurogenic Thoracic Outlet Syndrome and Pectoralis Minor Syndrome. Vascular Surgery, 373-380