Thoracic outlet syndrome: Year of the Zebra

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Introduction0:00–0:43

Thoracic outlet syndrome refers to a group of neurovascular symptoms that arise from compression of the nerves and blood vessels passing through the narrow space between the collar bone and first rib called the thoracic outlet.
This condition can be caused by a variety of factors that can compress the thoracic outlet and its structures. Factors can include neck injuries, certain cancers that invade the thoracic outlet or surrounding area.
Anatomical variants that predispose to neurovascular compression such as the presence of an extra cervical rib and certain activities or sports involving repetitive movements of the arm and shoulder, like swimming or baseball.
Regardless of the cause. Thoracic outlet syndrome can present with a variety of symptoms which vary depending on the specific structures that are affected and symptoms are usually unilateral occurring on only one side of the body.

Clinical Manifestations0:43–1:47

The most common symptoms result from compression of the nerves that innervate the upper limb, which can cause muscle weakness, numbness and tingling in the arm and hand on the affected side, especially when performing overhead activities or carrying heavy objects.
On the other hand, compression of the veins that drain the upper limb decreases blood drainage from the affected arm and hand leading to swelling of the upper limb and dilation of the veins of the neck and chest.
Finally, arterial compression decreases blood supply to the affected arm and hand muscles, resulting in a cold and pale extremity, numbness and cramping pain that occurs during activity and is relieved with rest.
Individuals with arterial compression may also have weak pulses and a lower BP in the affected arm. Diagnosis of thoracic outlet syndrome is typically made clinically based on history and physical examination of the affected upper limb symptoms can often be elicited by specific triggering maneuvers which narrow the thoracic outlet even further like Adson maneuver.

Diagnosis1:47–2:38

This maneuver involves palpating the radial pulse while the individual extends their elbow extends their neck and turns their head to the affected side while taking a deep breath.
A positive result is concluded if the radial pulse becomes weaker or absent. If thoracic outlet syndrome is suspected, a chest X ray or MRI may be ordered to identify the cause of the compression.
Advanced diagnostic techniques like electromyogram or nerve conduction studies may also be used to investigate if symptoms are due to nerve damage.
Treatment for thoracic outlet syndrome depends on the underlying cause and severity of the condition. In most cases, treatment involves a combination of physical therapy, postural changes and antiinflammatory medications like Ibuprofen to help decrease swelling and manage pain.

Treatment2:38–3:11

In cases where compression is caused by an extra rib or other anatomical anomaly surgery may be necessary to relieve the symptoms and if a tumor is causing compression surgery, chemotherapy or radiotherapy may be indicated.
All right, is a quick recap. Thoracic outlet syndrome is a group of neurovascular symptoms caused by compression of the nerves or blood vessels as they pass between the chest and upper extremity.

Review3:11–3:44

Causes of compression include trauma, anatomical anomalies, certain cancers and repetitive arm and shoulder movements. Symptoms depend on which structures are affected and may include pain, weakness and numbness of the affected extremity.
Diagnosis is made clinically and treatment can include physical therapy, anti-inflammatory medications or even surgery depending on the underlying cause.