Thoracic Outlet Syndrome Treatment

The most misdiagnosed condition after trauma to the neck and shoulders.

Thoracic outlet syndrome is a common injury that occurs after a variety of accidents . Whiplash is common factor resulting in traumatic thoracic outlet syndrome.

Typically, the injured person is behind a red light when another vehicle hits the vehicle from behind. The force and the Vector of the impact from the accident can hyperextend the neck and stretch the scalene muscles.

This can subsequently lead to bleeding, hypertrophy, scarring and shortening of the scalene muscle. This hypertrophy or fibrosis of the muscle can further narrow an already tight triangular tunnel through which the subclavian artery, subclavian vein and the brachial plexus pass.
Symptoms of thoracic outlet syndrome may not occur for several months after surgery


Symptoms of thoracic outlet syndrome:

Thoracic outlet syndrome is a complex disorder manifested by compression of the brachial plexus, subclavian vein or subclavian artery

Thoracic outlet syndrome is divided into 3 categories:

  • Neurogenic
  • Arterial
  • Venous

Neurogenic thoracic outlet syndrome is the most common type which results in pain and discomfort in the neck and shoulder area with pain and numbness radiating down into the forearm and the hand

This can cause of life long disability

Most common symptoms of neurogenic thoracic outlet syndrome include:

  • Neck pain
  • Shoulder pain-headache
  • Pain and numbness radiating to the arm and fingers poor hand grip
  • Aching of the hand or arm
  • Numbness and tingling of fingers

Arterial thoracic syndrome is less common and will results in compression of the subclavian artery. Subsequently the patient complains of a cold and an ischemic pain that can cause weakness. Again these symptoms may not manifest themselves for several months after the accident

Venous thoracic outlet syndrome can result from compression of the subclavian vein which consequently can cause swelling and bluish discoloration of the hand.

Treatment:

Treatment should start with conservative management including extensive physical therapy and pain management.

Medications:

These include anti-inflammatory medications such as naproxen and ibuprofen in addition to muscle relaxants that decrease the inflammation and the tension of the muscle and pain management

Anterior scalene block:

Anterior scalene muscle can be injected under fluoroscopic guidance with steroids. This block paralyzesas the muscle in spasm allowing the first rib to descend and decompresses the thoracic outlet

This is a valuable procedure both producing relief and also confirming the diagnosis of thoracic syndrome.

Chemodenervation:

Botulinum toxin Type A (Botox) can be injected into the scalene muscles relieving spasm, relieving symptoms and confirming diagnosis of thoracic outlet syndrome
This can be done under fluoroscopic or CT guidance.

In most situations conservative therapy and pain management is not sufficient and the pain and discomfort continues.
This can lead to a life time of physical and emotional disability. Doing even simple tasks such as writing , typing or lifting may become impossible secondary to severe pain and discomfort.

Most patients with severe thoracic outlet syndrome cannot hold a job

If conservative therapy fails, surgical therapy is an effective way to treat severe thoracic outlet syndrome.

During surgery the first rib is removed, enlarging the space for the neurovascular structure to pass through the thoracic triangle, subsequently relieving pressure and diminishing the symptoms

During surgery the fibrous tissue around the nerves is also removed by neurolysis relieving the symptoms.

This is an inpatient procedure which is done in a hospital. 2-3 days length of stay. This is not a common procedure done routinely however surgery is very effective in the hands of an experienced surgeon.

Any patient with a whiplash injury and pain in the shoulder, neck or the arm may suffer from thoracic outlet syndrome.

Thoracic outlet syndrome is a highly missed diagnosis after trauma.

If the diagnosis is not made accurately, patients can undergo pain management and even cervical neck surgeries without improvement in their symptoms

This can cause a lifelong disability and inability to work from a constant pain and weakness in the neck shoulder and arm.

Physical therapy can be an effective way to treat TOS however if physical therapy fails, surgery is very effective in treating TOS

Financial loss secondary to thoracic syndrome are substantial and include:

  • Loss of income most patients have to deal with loss of her job or under employment after
  • thoracic outlet syndrome secondary to severe disability,
  • Medical costs, this would include the costs of multiple procedures, long-term medications
  • and injection procedures
  • Pain and suffering
  • Disfigurement
  • Loss of enjoyment of life

Symptoms of thoracic outlet syndrome may not start for months after an accident.

Peripheral arterial disease is diagnosed and treated at Encino Vascular Institute with minimally invasive procedures