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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. 

Thoracic outlet syndrome - Surgery

You will probably reach Isokinetic 3-4 weeks after surgery. You will wear a protective brace with an intrarotated limb in the post-surgery phase until the moment in which stitches will be taken out.

You could be asked to undergo complimentary exams such as an EMG, if sensibility deficits or problems related to the strength of the superior limb are persisting, an arterial and venous eco-color-doppler, if symptoms such as the reduction of the radial wrist or haedema/congestion of the hand and forearm are relevant, as well as for the clinic monitoring.

The rehabilitation treatment post-surgery differs from the conservative treatment. 

Thoracic outlet syndrome - Rehabilitation

The rehabilitation treatment post- thoracic outlet syndrome surgery differs from the conservative treatment, as at least at an initial stage it is more directed to the recovery of the range of motion rather than the correction of the postural incorrect behaviours. 
The main difference is that after a period of partial immobility of the operated part of the superior limb, the focus will be on the recovery of the dynamic stability of the cervical-scapular-thoracic part before starting with an active work with the flexion and abduction of the shoulder. 

In the initial stages of recovery, it is useful to follow rehabilitative therapies in the pool as well, so to quicken the process of recovery of the range of motion. 

The early moments of the rehabilitation will be more intense. For a sportsperson, the number of sessions will be higher (both in terms of weekly frequency and weeks for the treatment) and returning to sports is suggested not before 3 months from surgery.
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