Thoraco-brachial outlet syndrome: what is it?

2023-12-12 20:25:00

Thoraco-brachial outlet syndrome (Sd DTB), also called thoraco-brachial crossing syndrome (STTB) is a relatively unknown medical condition that can nevertheless have significant repercussions on quality of life and employability of the people concerned. Often diagnosed late, it manifests itself as nerve compression, sometimes venous and/or more rarely arterial in the area located between the clavicle and the first rib of the rib cage.

Definition: what is thoraco-brachial outlet syndrome (TBD)?

Thoraco-brachial outlet syndrome (TBD) is a complex and difficult to diagnose medical condition, which manifests as a compression of blood vessels (veins or arteries) and/or nerves between the clavicle and the first rib, in what is called the thoraco-brachial passage. Depending on the area affected by the compression, patients may experience a variety of symptoms affecting the arm, the hand, and sometimes even the neck and shoulder.

What are the causes and risk factors?

Thoraco-brachial outlet syndrome (TBD) can have diverse and often complex origins. As the Lyon University Hospital indicates, “ six anatomical zones are crossed by the vascular and nervous bundle and are possibly the origin of the compression: the so-called procession of the suspensory apparatus of the pleura, the interscalene procession, the costoclavicular procession, the clavipectoral region, the retro-small pectoral region and the region anterior to the humeral head” (source 1).

Several factors can contribute to the development of DTB syndrome, such as congenital anatomical anomalies (an extra cervical rib or short clavicle, for example) or shocks and traumatic injuries (like a broken collarbone).

Certain professional activities requiring repetitive movements of the upper limbs (such as frequent data entry or heavy lifting) can also be responsible for vascular or nerve compression.

Finally, people who practice sports involving large, repetitive arm movements (as is the case in throwing or pulling sports) are more likely to develop this syndrome.

What symptoms should alert you?

Symptoms of thoracobrachial outlet syndrome vary from person to person depending on the compression site. They generally include pain and numbnessof the tingling and an feeling of weakness in the arm, hand, and sometimes even in the neck and shoulder. And the Lyon University Hospital clarified (source 1):

In the event of nerve compression, patients may present with neck painfrom the shoulder, from the axilla even up to the fingers,tingling and an decreased motor strength of one or more muscle groups going as far as dropping objects.
In the event of arterial compression, patients may present pain during exercise, weaknesses in the use of the arm, Raynaud’s syndrome and skin necrosis related to an aneurysm of the subclavian artery.
In the event of venous compression, patients may present with swelling of the arm and hand during exercisea arm heaviness when using the arma phlebitis of the upper limb and large subcutaneous veins on the pectoral.

So many symptoms which can sometimes be confused with those of a stiff neck, facial pain or even fibromyalgia! Besides, you guessed it, they can seriously impair quality of life : certain everyday actions such as washing your hair, hanging out your laundry, holding a steering wheel, carrying groceries or changing a light bulb can become too difficult to carry out.

Good to know: symptoms tend to worsen over time and during or after activities that use the upper limbs!

Which specialist should you consult if you suspect thoraco-brachial outlet syndrome?

If you suspect thoraco-brachial outlet syndrome (TBD), start by consulting a general practitioner. He or she will be able to assess your symptoms, take your medical history and perform an initial physical exam, then redirect you to a specialist for more in-depth investigations and adequate treatment.

Depending on your symptoms, your general practitioner will redirect you to a neurologist, vascular surgeon, orthopedic surgeon or physiotherapist. Very often, the collaboration of these experts is necessary to develop a complete and personalized treatment plan!

Diagnosis: what tests to know if you really have DTB syndrome?

The diagnosis of thoraco-brachial outlet syndrome requires a complete clinical examination and the performance of several additional examinationsrecalls the Nantes University Hospital.

During the first consultation, describe your symptoms, their evolution and any triggering or aggravating factors that you have identified. Your doctor will ask you detailed questions about your medical historyincluding any trauma, injury, or work activity involving repetitive movements that may be related to your symptoms.

Depending on his specialty and his diagnosis, he will be able to prescribe examinations such as x-rays or of theIRM (Magnetic resonance imaging) du rachis cervicalor one electromyogram. Objective ? Evaluate the structure of blood vessels and nerves, but also locate the area of compression. If your doctor suspects blood vessel compression, vascular tests, such as pulse measurement or Doppler exams can also be made.

It is important to consult quickly in the event of persistent symptoms, because early diagnosis can improve the treatment prospects and contribute to better management of thoraco-brachial outlet syndrome!

What is the candlestick test?

The candlestick test, also known as the test the Rose or of vascular trigger test, is a test carried out as part of the clinical examination necessary for the diagnosis of DTB syndrome. It aims to reproduce symptoms associated with compression of blood vessels or nerves in the thoraco-brachial region.

Patients remain standing with their shoulders slightly extended, elbows bent 90 degrees and forearms in a supinated position (palms up). They must then perform specific movements, simulating daily actions or repetitive movements of the upper limbs. During this time, the practitioner carefully observes the patients’ reactions. If the test triggers symptoms such as pain, numbness, tingling, or other abnormal sensations in the arm, this may indicate compression of structures in the thoraco-brachial region.

Treatment: how to relieve pain and treat this syndrome?

Management of thoraco-brachial outlet syndrome depends on several factors, such as the age and state of health of the patients, the presence or absence of anatomical malformations, the profession and hobbies of the patients, the site of the compression and its extent, etc. It generally aims to relieve symptoms and to reduce compression structures in the thoraco-brachial region.

For this, a so-called “conservative” treatment is generally sufficient: it consists of focusing on rehabilitation exercises specific to strengthen the muscles of the thoraco-brachial region, improve posture and reduce compression of nerves and blood vessels during physiotherapy sessions. Of the anti-inflammatory drugs may be prescribed to relieve pain, or even muscle relaxers or some Botulinum toxin injections. Without forgetting that changes in lifestyle habits (personal or professional) may prove essential!

In certain rare cases, when symptoms persist or worsen despite the conservative measures mentioned above, surgical intervention may be considered. It consists of creating sufficient space to allow decompression of the vascular and nervous elements. Several surgical techniques can be considered depending on the elements to be decompressed, notes the Nantes University Hospital (source 2).

How to prevent thoraco-brachial outlet syndrome?

Prevention of thoraco-brachial outlet syndrome relies on the adoption of good practices in terms of posture, ergonomics and general health. Here are some recommendations to reduce the risk of developing DTB or alleviate its symptoms:

Avoid maintaining uncomfortable positions for your shoulders or neck.
Adopt proper posture during your daily activities, especially at work. Make sure you have an ergonomic chair and desk, and avoid staying in the same position for long periods of time.
As far as possible, avoid excessive repetitive movements. If your job or activities involve repetitive arm movements, take regular breaks to allow your muscles to relax and vary the movements as much as possible.
Include muscle strengthening exercises for shoulders, neck and upper back in your workout routine.
Practice regular stretching to help maintain muscle flexibility and prevent tension. Focus on the muscles of your upper back, shoulders and neck.
If you practice physical activities, make sure you warm up properly before exercising to prepare the muscles for exercise.
Moreover, try to maintain a healthy weight to reduce pressure on upper body structures.