Thoracic outlet syndrome

Overview of thoracic outlet syndrome is the subclavian artery and vein, and brachial plexus in the thoracic outlet oppression resulting from the series of symptoms. Cause nerve compression and / or the reasons for abnormal bone, such as cervical rib, 7 cervical vertebra too long. No. 1 rib or collarbone two forks deformities, exostosis, caused by trauma or a collarbone fractured ribs, dislocation of the humerus head, and so on. In addition, there are scalene muscle cramps, fibrosis; Aiguillette ptosis and outreach arm of excessive thoracic outlet may cause stenosis. have subclavian artery and the brachial plexus symptoms of oppression. Besides the normal upper limb movements such as outreach arm, shoulders drooping back, neck extended, face to the opposite side, and the deep inspiratory rib can also lock gap narrowing, nerve and vascular oppression by the extent of increase (Figure 1). Figure 1 thoracic outlet syndrome Map -- scissors-like oppression pathogenesis upper thoracic outlet for the collarbone, as a lower bound ribs, the front of the rib ligament, the rear for scalene. Costoclavicular space above being scalenus divided into before and after the two parts. Subclavian vein in the former scalenus the front and subclavian between muscle; subclavian artery and the brachial plexus is located at the rear of Scalenus with the scalene muscle between (Figure 1). Figure 1 scalenus with subclavian action between the vein and brachial plexus anatomy (clavicle resection) pathological changes in nerve compression injury often leave inflammatory swelling kind, first sensory fibers involved, only motor neurons appeared in the late pressure. This serious symptoms, the more difficult to restore. Nerve compression time is too long will lead to adoption of sympathetic vasomotor obstacles. Subclavian artery wall can be changed, the outer membrane thickening artery, and interstitial edema associated with the same membrane thickening of the lumen thrombosis. Early platelet thrombosis of the cellulose type, there will be Renault's (Raynaud) phenomenon. Reflex sympathetic fibers can increase contraction fingertip vascular obstruction. Intravenous excessive outreach or be settled within oppression, observed blood current stagnation and peripheral venous pressure rise, oppression gone back to normal. Vein repeated injury similar inflammatory fibrosis-like change, intravenous was white, translucent lost state and decreased caliber form of collateral circulation. Early trends for venous thrombosis, such as collateral circulation has been formed, the finger can cause necrosis. Diagnosis based on history, local medical examination, chest and cervical X-ray and ulnar nerve conduction velocity, generally can be identified. Thoracic outlet syndrome in the differential diagnosis of cervical disease should consider, brachial plexus or upper extremity peripheral nerve disease, vascular disease, heart, lung, mediastinal disease. Suspected angina patients requiring electrocardiogram and selective coronary angiography.