WHAT IS IT? THORACIC OUTLET SYNDROME

An umbrella term used for a group of conditions that cause compression on the nerves coming out of the neck and down the arm. Mainly due to the pinching of nerves between the area of the collarbone and first rib.

Consult your Doctor

If you experience any of the following symptoms then please contact your doctor or GP:

  • Persistent, unexplained dizziness, nausea, and vomiting

  • Severe headaches

  • Feel feverish or generally unwell

  • Unexplained weight loss

  • Double-vision.

  • Any violent trauma- e.g. fall from height/ road traffic accident

  • Have a history of Cancer

  • Problems with swallowing or speech

Signs & Symptoms

  • Can either have a gradual or sudden onset

  • Symptoms of pain/weakness/burning discomfort which affect the arms and hands.

  • Sharp pain or swelling down the arm.

  • Pins and needles, or numbness (often at night) in the arms and hands.

  • Pain up the arm to the neck.

  • Weakness of grip.

  • Clumsiness when holding objects.

  • Easing of symptoms by shaking hands or tilting head away from painful side.

  • Discolouration (black or red patches) involving the arm or neck due to blood clots

  • Raynaud’s Syndrome- paleness in hands

  • Can have associated symptoms such as neck pain or reduced neck range of movement

  • If often related to poor posture (forward head posture, rounded shoulders, upper cervical extension)

  • Clamminess, sweating and discolouration in hands and arms.

What Causes It?

  • Tight muscles around the head and neck (scalenes, sub occipital muscles, upper trapezius, SCM, splenius capitis and cervicis)

  • Poor posture- shoulders kept back and erect.

  • Dysfunction of cervical and thoracic joints

  • Abnormal positioning of the head and neck in conjunction with poor ergonomics- sitting at a desk with the incorrect workstation set-up.

How to Self Manage

  • Heat- hot water bottles/ heat packs around the neck to help relax muscles.

  • Ice (no direct ice to skin) can be used to treat severe pain and swelling.

  • Gentle neck stretches and movements in all directions, but not to extremes.

  • Gentle chin tucks- keeping the head level and tucking the chin backwards- holding this for 5-10 seconds and repeating 5 times regularly throughout day.

  • Anti–inflammatory medication or painkillers are helpful to reduce pain and swelling.

  • Muscle relaxants with ease muscle spasm.

  • Use a pillow or 2 to bridge the gap between the head and shoulders if sleeping on your side- or a small pillow if sleeping on your back.

Prognosis

  • Depending on the cause, symptoms can be improved with conservative management (physiotherapy) if the injury has been present for less than 4-6 weeks.

  • If you have been experiencing pain/ pins and needles/ numbness/ weakness in hands and arms for more than 4-6 weeks- then please consult a doctor as you ma require an MRI scan.

  • Corticosteroid injections if conservative management is unsuccessful with help to reduce pain and inflammation.

  • Surgery may also be indicated following an unsuccessful cortisone injection if symptoms of continuous pain, numbness, weakness and pins and needles have been affecting arms and hands for more than 12 weeks.

  • If there is some long-term symptoms in the nerves which have been affected- doctors/ consultants can prescribe neuropathic pain medication- such as: Gabapentin, Amitriptyline, and Pregablin.

How Physio Helps

  • Assessment to establish if symptoms are being caused by joints or discs, or muscles pinching on nerves.

  • Soft tissue massage to release tight muscles, and muscle spasms causing pain.

  • Electrotherapies including ultrasound/ Acupuncture or dry needling to improve circulation reduce swelling.

  • Prescription of strengthening exercises to address muscle tightness and improve neck stability.

  • Nerve mobilisation to reduced tension on the nerves.

  • Provision of stretches and home exercises for rehabilitation to strengthen the neck and 

  • Mobilisation techniques to take the pressure off the joints and discs.

  • Review of workplace/sporting ergonomics.

References

  • APTA (2017) Neck Pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. American Physical Therapy Association. www.ncbi.nlm.nih.gov/pubmed/28666405

  • Cote, P. et al (2016) Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal. Springer. www.ncbi.nlm.nih.gov/pubmed/26984876

  • Kjaer, P. et al (2017) National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal. Springer. www.ncbi.nlm.nih.gov/pubmed/28523381

  • Williams,N.H. and Hoving,J.L. (2004) Oxford textbook of primary medical care. In: Jones,R., Britten,N., Culpepper,L., Gass,D., Grol,R., Mant,D., Silagy,C. (Eds.) Neck pain.Oxford: Oxford University Press., 1111-1116.

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