Thoracic Outlet Syndrome
Diagnosis of Thoracic Outlet Syndrome
Thoracic outlet syndrome is becoming more widely known to general practitioners but is usually not the initial thought when determining a diagnosis. The symptoms can be varied, intermittent, and overlap with many other conditions such as disc bulging or herniated disc, pinched nerves, Raynaud’s syndrome, muscle strains, diabetic neuropathy, and numerous other medical ailments. Misdiagnosis as fibromyalgia, multiple sclerosis, rotator cuff injuries, cervical disc degeneration, spinal stenosis, cervical arthritis, complex regional pain syndrome, or tumors of the spine are unlikely but may delay the correct diagnosis and treatment of the condition thereby potentiating irreversible damage to the brachial plexus and blood vessels in the thoracic outlet.
Steps of Diagnosis
A physician will conduct a physician examination, and take a thorough history including trauma and history of infections. Car accidents and work-related injuries commonly trigger symptoms. Even repetitive minor trauma, such as from playing contact sports, can lead to thoracic outlet syndrome, making it very important to inform the diagnosing physician of such injuries. The doctor may ask the patient to raise their arms to see if the symptoms are reproduced. If the patient experiences numbness, tingling, pins and needles, in the arm and hands (particularly in the little finger) then this can indicate the presence of neurogenic thoracic outlet syndrome. If the palm of the hand turns pale and the fingers and forearm are cold to the touch upon elevation above shoulder height then the patient is likely to be diagnosed with vascular thoracic outlet syndrome. Disputed or nonspecific thoracic outlet syndrome poses a difficult diagnostic quandary for most physicians as symptoms may overlap and have no clear pathogenesis.
Pressure placed on the area between the armpit and the lower neck can also reproduce the symptoms, as can stretching the neck away from the body. These reproductions of symptoms are caused by the movements decreasing the spaces in the thoracic region, putting the nerves and blood vessels under acute pressure. Measuring the pulse in the wrist whilst the arm is raised can also assist the physician in diagnosing thoracic outlet syndrome as the pulse is likely to weaken, or in extreme cases disappear altogether, where pressure is placed on the blood vessels in the thoracic outlet.
Nerve stimulation tests, such as electromyograms can support a diagnosis, as can angiograms and x-rays. MRI scans may show compression of the brachial plexus area and thoracic region and highlight any soft tissue inflammation, pinched nerves and compressed blood vessels. X-rays can be helpful in showing the presence of a cervical rib and the concomitant reduction of space in the thoracic region.
Next read about: Thoracic Outlet Syndrome Treatment
Last Updated: 10/04/2010