jetharrs@pacific.telebyte.net on sun 9 mar 97
Quoting from an article by Dr. Jeffery Bernstein (e-mail:
jeffbernst@aol.com--may be an old address):
"Thoracic Outlet Syndrome is a common but often misunderstood problem which
affects the arm and hand. Compared to circulation and nerve problems that
affect the leg, problems affecting the arms and hands are less common.
Thoracic Outlet Syndrome, like Carpal Tunnel Syndrome, affects people in
their most productive working years.
(the articles goes on to describe symptoms of a teacher who experienced
pain while writing on the blackboard, driving a car, riding her bike, and
found that she had to sleep with her arms at her sides to avoid pain.)
The thoracic outlet is a narrow, strategic area at the juction of the neck,
arm and chest. Important nerves and blood vessels that supply the arm and
hand pass through this narrow area. It can affect either the artery, vein
or nerves separately or in various combinations. Typical symptoms of TOS
include pain, numbness and tingling, temperature changes, weakness,
disturbed sleep and loss of muscle mass. These symptoms generally affect
one or both of the hands. Pain is typically aggrevated with any activity
which requires arm elevation.
TOS can be difficult to diagnose. Many paitents with TOS have other nerve
compression problems as well. It usually requires examinations by more
than one specialists to accurately reache the diagnosis. Neurologists,
vascular sergeons, orthopedists and rheumatologists are often consulted.
The first line of treatment is to modify any physical activity that
produces the apin. Medications can be given to reduce pain and
inflammation. Physical therapy is very important. Exercises are given to
stretch the scalene muscles, improve posture and mobilize the shoulder
blades. Massage and other treatments may often be helpful.
Surgery can be performed to relieve the pain, but only as a drastic
solution. During surgery the scalene muscles are removed from their
attachements on the first rib."
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