Makindo Medical Notes.com

The symptoms usually are made worse when the arms are positioned overhead.

About

• A cause of wasting of thenar muscles and pain and weakness
• Can affect nerve/vein or artery

Aetiology

• A fibrous band or cervical rib from the tip of the C7 transverse process towards the first rib compresses the lower brachial plexus roots, C8 and T1.

Clinical

• Seen in young adults and commoner in females
• Pain in the forearm pain on the ulnar border
• T1 sensory loss and thenar muscle wasting
• Weakness of abductor pollicis brevis
• Ipsilateral Horner syndrome
• There may also be subclavian vein/artery compression
• The arm can be cold or blue or swollen

Investigations

• CXR: may be visible on CXR
• CT/MRI will show band

Management

• Physiotherapy may help and pain relief measures. Advice such as avoid carrying heavy bags over your shoulder, because this can increase pressure on the thoracic outlet.
• Stretch daily, and perform exercises that keep your shoulder muscles strong. Daily stretches focusing on the chest, neck and shoulders can help improve shoulder muscle strength and prevent thoracic outlet syndrome.
• Weight loss is advised if obese
• Most people improve with these approaches. Surgical excision may be needed in some cases.
• Surgical management may involve the release of the scalene muscles and/or removal of the first rib. This operation frequently is done with an incision above the collarbone. However, your surgeon instead may recommend a surgical approach through the armpit.

References