Thoracic Outlet Syndrome
Thoracic Outlet Syndrome
( Shoulder Trap Disease )
As the name suggests, it is a disease that is difficult to understand and often difficult to diagnose. It has been called by many names until today. The most widely used is now thoracic outlet syndrome. Although it does not have a Turkish equivalent, it is also called shoulder trap disease among the people according to the region of the disease.
As can be understood from the definition, it is the complaint of patients on their shoulders, arms and/or hands due to a trap that occurs in the shoulder region.
The thoracic outlet is the space between the 1st rib (rib) and the collarbone that goes towards the arm.
There is one main artery (arteria subclavian), one vein (vena subclavian), and nerves (brachial plexus) going from this space towards our arm. With the narrowing in this area, these veins or nerves can be compressed.
As a result, it can cause serious problems for the patient. Complaints in shoulder trap disease occur due to compression of the vessel or nerve.
Nerve compression is usually in the foreground. Vascular compression is rare. Sometimes, both nerves and vessels can be compressed together.
After nerve compression, tingling and numbness in that arm and/or hand initially starts in general patients. This is sometimes felt in the shoulders as well. If the disease progresses, it can go up to muscle weakness and muscle wasting. This complaint is very evident especially in movements where the arm and hand are used and in situations that need to be lifted upwards. The pain can become unbearable.
In vascular compression, which is less common, scaling on the skin, shedding of hair, and if there is a wound, delays in healing can be seen in that area due to the malnutrition, which we call coldness, pallor and trophic disorder in the arms and hands.
The causes of shoulder trap disease are mostly due to congenital anomalies. It is possible that it may occur in later periods as well. Congenital patients usually have more ribs. This is called the cervical rib. This bone can be detected radiologically. However, this disease does not occur in every cervical rib. Apart from that, the condition of the neck muscles can create this disease. There are also structures called fibrous bands that cannot be detected by other assays. They can compress blood vessels or nerves like strings. Sometimes, shoulder trap syndrome can occur again due to a shoulder injury in a later accident or doing a special job. There are other diseases that mimic this disease. The most important thing is to separate it. Sometimes, a diagnosis of shoulder trap disease is made by mistake. As a result, the complaints of the patients do not go away.
The main ones of these diseases are cervical disc herniation (neck hernia), tarsal tunnel syndrome
(compression of the nerve at the elbow), carpal tunnel syndrome (compression of the nerve in the wrist) and some muscle diseases.
A good evaluation of all these; taking a good disease history, performing physical examination and tests.
The tests we have help us if the disease is very obvious. However, it does not show us a complete way in cases in between.
Thoracic Outlet Syndrome Diagnostic Stages
Methods used in diagnosis;
1- To find out if there is cervical xota and is there any other disease in the lung? Chest X-ray is taken to evaluate it. If there is a situation in between, tomography or MRI is taken.
2- EMG is requested to evaluate the nerve compression. An ulnar nerve conduction velocity of less than 600 mm/sec may suggest direct surgical treatment. Normal is 72mm/sec. Supportive therapy is given at intervals in between.
3-Doppler ultrasonography and, if necessary, vascular angiography are performed to evaluate vascular compression.
Thoracic Outlet Syndrome Treatment
If a significant nerve or vascular compression is detected in the diagnosis, our first priority is surgery. However, a full diagnosis cannot be made or if the compression event has just started and has not caused damage or if the pressure is mild, it is treated with non-operative methods.
At the beginning of these methods are physical therapy, drugs and posture training. As we have mentioned above, other patients who may complain of shoulder traps should be examined and it should be revealed that they do not cause this complaint.
We never first operate on patients with thoracic outlet syndrome. Other treatment modalities must be considered. However, surgery is planned in the first place for those with very significant nerve or vascular compression. What is performed in the surgery is the removal of the cervical excess rib, if any, along with the removal of the first rib, scalene muscle resection and, if any, fibrous bands are resected. Thus, all tissues that can constrict around nerves and vessels are released. Even in the early period of the operation, it is observed that the old complaints of the patient are gone.
Long-term results are also very good. There will be situations that patients should pay attention to especially in their home and business life after the surgery. If a good diagnosis is made and appropriate treatment is done, it is possible to save the painful life of patients with thoracic outlet syndrome.
Thoracic Outlet Syndrome (Shoulder Trap Disease) Short Facts
Ankara Etlik City Hospital Chest, Cardiovascular Diseases Hospital
Varlık, Halil Sezai Erkut Cd. No:5, Yenimahalle/Ankara