Thoracic Outlet Syndrome Symptoms
The predisposing factors responsive for the development of thoracic outlet syndrome are fibromuscular bands, bony protuberances and long or larger transverse processes, this together with the tendinous or cartilaginous muscular insertions are responsible for the compression of the neurovascular structures at the thoracic outlet.
These abnormalities or variations of the anatomy of this area produce symptoms of thoracic outlet syndrome that have been triggered by trauma or repetitive work. The symptoms may spontaneously occur because there are patients who have symptoms of thoracic outlet syndrome without a history of trauma or repetitive work. The compression occurs in three anatomical structures, arteries, veins and nerves; isolated, or more commonly two or three of the structures are compressed. Compression can be of different magnitude in each of these structures. Therefore symptoms can be protean.
For example, the subclavian vein can be the only compressed structure and this patient might have a thrombosis of the vein that was called in the past effort thrombosis, or a swelling of the fingers. The subclavian artery can also be compressed with symptoms of temporary, arterial, positional insufficiency of the upper extremity. When they are present for a long time, aneurysm and thrombosis of the subclavian artery may develop with distal embolization. Nerve compression of the brachial plexus is very common and is or not associated with venous or arterial compression. Neurocompression can exist without vascular compression.
The intermingling of all this compressions, the degree, and which of the three anatomical structure is the most compressed, might produce protean manifestations of the symptoms in these patients. They are difficult to interpret unless the health provider is aware of the symptoms and the physical examination of thoracic outlet syndrome.
If any individual who has a predisposition for thoracic outlet syndrome performs repetitive work with the upper extremity, it is very likely that he will begin to have symptoms in the first few months after he or she starts to work. On the other hand, some people who may have predisposition may take a longer time and it would take years of repetitive work to show the symptoms of thoracic outlet syndrome.
They may have had symptoms for a long time, without being aware of them, and at one point in time the symptoms become worse and this is when they are first noticed. The individual is affected because he feels tinglingness and weakness and heaviness of the hands and arms, pains in the chest, pain in the upper back and in the neck. It is difficult now to perform the same type of work that before was easy to do. Also the weakness of the hands, sometimes dropping of objects, make it difficult to perform repetitive work.
What symptoms does the patient have? The patient may have few or many symptoms. You can see in the web page the origin of the symptoms, the name of the symptoms, and how they can be classified; they can be together, separate, or isolated and can have a venous, arterial, or neurologic origin. The symptoms also refer to the structure that is compressed and the degree and the association with the others. Some of the manifestations are protean, like anterior chest pains, and if the doctors are unaware of this manifestations, the diagnosis is difficult to make.