THORACIC OUTLET SYNDROME

It is a complex condition in which blood vessels and/or nerves are entrapped or compressed as they exit the thorax. It is caused by a compression of the brachial plexus and subclavian vessels as they exit the neck into the shoulder region and pass under the first rib. 
Symptoms: - pain, altered sensation and weakness of upper limb.
- Pins and needles, numbness in fingers.
- Muscle spasms in arm and hand.
- Heaviness fatigue in arm.
- Pain at rest and at night.
- Pain or discomfort above or below collarbone and may radiate down the arm. - Altered sensation and temperature in the arm and hand.
- Symptoms are generally aggravated or exacerbated by lifting your arm or turning your head or neck (Lindgren & Oksala, 1995). Risk factors:
- Bony abnormalities eg. Abnormal first rib or a cervical rib.
- Trauma to neck or upper body
- Poor posture
- Job related or sporting activity involving repetitive overhead movements.
- Weight gain

Tests: - Adsons test (pulse taking) - Roos test (Chicken dance) 😂
- Clear the neck with Cx EROM Extension, rotation and apply gentle overpressure. 
Investigations:
- Cervical spine xrays - MRI
- EMG to rule out other causes
- Botulism toxin into the pectoral muscle 
Physio treatment: - Postural and ergonomic advise and intervention
- Rest from aggravating activities
- Strengthening of scapular stabilises
- Mobilization of thoracic and first rib
- MFR of pec minor, scalenes and back muscles - Neural gliding exercises 
Surgery should only be considered if conservative treatment has failed (MacKinnon & Novak, 2002)