Thoracic outlet syndrome
Introduction
Introduction The space between the clavicle and the first rib is called the thoracic outlet. When the nerve or blood vessel is embedded at this exit, a series of clinical symptoms such as neck and shoulder pain and numbness of the fingertips may occur, called the thoracic outlet syndrome. There are several subtypes of thoracic outlet syndrome depending on the cause, but sometimes it is difficult for clinicians to determine the exact cause of the thoracic outlet syndrome. Treatments for thoracic outlet syndrome include physical therapy, medication, and surgery. Simply stated, the cause of thoracic outlet syndrome is the manifestation of signs of brachial plexus and subclavian blood vessels being squeezed under the clavicle.
Cause
Cause
Causes of thoracic outlet syndrome
Simply stated, the cause of thoracic outlet syndrome is the manifestation of signs of brachial plexus and subclavian blood vessels being squeezed under the clavicle. Specific to the cause of the extrusion, it is divided into the following cases:
Anatomical defects: Invasive compression of the outlet nerve vessels caused by congenital factors, often caused by neck ribs and excessive tension in the fiber band between the cervical spine and the ribs.
Poor posture: Frequent low-thoracic shoulder-shoulder postures (writing at the desk, etc.) can cause pressure on the exit.
Trauma: Trauma, such as a car accident, can cause changes in the anatomical shape of the outlet and cause symptoms of compression. The post-traumatic thoracic outlet syndrome often lags behind.
Repetitive sports injuries: Repetitive movements can cause damage to body tissues, causing pathological changes such as tears, bleeding, scars, and compression of the exit. Long-term computer operation and typing, production line assembly work, the finishing of the book shelves and the people who have raised their heads will easily appear symptoms after this. Certain sports can also be caused, such as freestyle and baseball players. The slanting backpack, the shoulders are long-term lifting weights, and the weights of the shoulders and hands are also raised.
Excessive body weight: Excessive weight can also cause changes in the joints around the exit, causing symptoms.
During pregnancy: changes in hormone levels cause relaxation of the joint ligaments, changes in exports, causing symptoms.
Examine
an examination
Related inspection
Dynamic electrocardiogram (Holter monitoring) thoracoscopic examination
Because the clinical manifestations and performance of the thoracic outlet syndrome vary widely, clinical diagnosis is not easy.
Routine inspection: Ask about occupations, physical examinations, etc. Press the patient's shoulder arm as follows to observe the skin color of the hand and check the joint mobility.
Check: Adson"s test, Wright test, Roos stress test.
X-ray: The X-ray of the neck and chest can be found in the presence of cervical ribs, excluding other possible abnormal bone lesions.
Magnetic Resonance Imaging (MRI): MRI can detect and eliminate the compression of brachial plexus and subclavian blood vessels by soft tissue lesions, and can confirm the compression of thickening and hypertrophy of the fiber band from cervical to rib. The condition of the plexus and subclavian vessels is very helpful for diagnosis.
Electrophysiological electromyography: understanding the nerve conduction.
Diagnosis
Differential diagnosis
Differential diagnosis of thoracic outlet syndrome:
The abscess breaks into the chest cavity: the elderly lung abscess has chest pain, the inflammatory lesions are caused by the pleura, and the pain is aggravated during breathing. If the abscess breaks into the thoracic cavity, it can form empyema, pyo-pneumothorax (pyopneumothorax), or encapsulated empyema due to cellulose wrap, the patient's respiratory movement is limited, and the shortness of breath is aggravated.
Pleural effusion: a potential pleural cavity between the visceral and parietal pleura. Under normal circumstances, the pleural cavity contains a small amount of liquid, which makes the two pleuras lubricate during respiratory movement, reducing friction, and its production and absorption often In dynamic balance. Pleural effusion occurs when any pathological condition accelerates its production and/or reduces its absorption.
Thoracic collapse: One side of the thoracic collapse can be caused by empyema or pleurisy, extensive pleural thickening adhesions and contractions, atelectasis, pulmonary fibrosis, chronic fibrotic tuberculosis, chronic lung suppuration and other diseases.
Pleural adhesion: The so-called pleural adhesion is the adhesion of the two layers of the pleura. This lesion is caused by tuberculosis, pleurisy, and chest injury.
