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Thoracic outlet syndrome

The term “thoracic outlet syndrome” involves a series of usually bilateral symptoms determined by the compression of nervous and/or vascular structures by bony muscular ones. This compression may be due, however, to the alteration of the postural equilibrium of the scapula as well as by the prolonged activity of the superior limb over the head or by arthrosis of the cervical rachis, provoking a reflex contracture of the scalene muscles.

This phenomenon is more common in women between 20 and 50 years old, in sportsmen involved in body building with over the number ribs and hypertrophy of the scapula and in patients involved in water polo.

Symptomatology is typically intermittent and related to the position of the superior limb. It is characterised by the combination of symptoms and clinical signs that refer to the cervical rachis, to the shoulder, the arm and hand, isolated or combined that tend to worsen when the arm is lifted up the head, since the anatomic space devoted to the passage of the vascular-nervous structures is reduced.

This syndrome may cause throughout time chronic headaches, strength and co-ordination deficits of the superior limb, impossibility to perform working activities involving overhead gestures (painter, storekeeper…), or the Raynaud phenomenon that can lead also to the appearance of cutaneous ulcers on the arm or hand.
To diagnose the syndrome properly, the physician will prescribe you different clinical examinations, starting from the radiography, passing through the three-dimensional CT scan.
The suggested treatment is the conservative one and it tends to correct the postural behaviours such as the shoulder’s fall, the excessive retroposition of the shoulder and wrong behaviours performed in the ordinary life (bearing heavy objects, prolonged overhead gestures, sleeping on the painful side or with a limb in hyper-abduction).

In case the conservative treatment fails, it will be necessary to proceed with surgery. 

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