Thoracic Outlet Syndrome
In this condition the pain in the shoulder could be radiating pain from
muscles in spasm in the lower neck area. The thoracic
outlet is the area in the upper thoracic cage and
below the clavicle where the neurovascular bundle passes through
to the arm. There are differences of the angle of the upper opening
of the thoracic cage between various persons, some are born with
additional ribs and some with abnormalities of the scalene muscles
that can form a sling.
This can put pressure onto the brachial plexus, which in turn can cause neck and shoulder pain with associated arm numbness, arm weakness, shooting pains into the arm and numbness in fingers. The nerve roots that paticipate in the formation of the brachial plexus originate from the lower cervical spine and are numbered C5, C6, C7 and C8. When the C6 nerve root is irritated the thumb would experience numbness and C6 innervated muscles such as the shoulder and arm muscles would ache and get weak. When C8 gets irritated there would be a mimicking of an ulnar nerve entrapment with numbness of the 4th and 5th fingers and weakness of the small hand muscles, making it difficult for the person making a fist and grasping items.
Some people are born with additional
ribs attached to the lower cervical spine vertebral
bodies (a cervical rib). This puts direct pressure onto the brachial
plexus, particulalarly with the arm elevated. There is a lot af
variation with the anatomy in the thoracic outlet from person
to person and in some people the space where the subclavian artery
travels into the arm can by more narrow than usual. This can be
because of the angle of the rib cage, but can also be because
of a cervical rib that compresses the artery and the brachial
plexus or because of fibrous bands in association with the anterior
scalene muscle. This muscle can be located behind the subclavian
artery or it can be divided into two parts and squeeze the subclavian
artery in the middle of it.
Diagnostic tests: Imaging studies (ultrasonic studies and MRI scan) and clinical examination can pinpoint the particular cause. The Adson test consists of testing the radial pulse and elevating the arm at the same time.
When you picture an abnormality of the thoracic outlet as indicated above where the subclavian artery gets hooked, the link shows how with the Adson test the pressure on the the sublavian artery will clamp down the blood supply to the arm and the radial pulse disappears. This is called a positive Adson test and is indicative for the presence of a thoracic outlet syndrome.
Thoracic outlet syndrome treatment: Milder cases may
respond to physiotherapy, posture training and chiropractic corrections.
Occasionally a rib resection has to be done by a chest surgeon,
but this will not always lead to a resolution of this problem.
Sometimes the nerve damage is permanent leading to a chronic pain
syndrome, which can be very frustrating for patient and physician
alike.
There is an FDA approved non-drug method available, IceWave
patches from Lifewave, which will control pain. This is
mentioned in the book "Breakthrough" by Suzanne Somers
(Ref. 7) where newer insights of antiaging medicine are also reviewed.
Although the patches are placed over acupuncture points, there
are no needles involved. Nanotechnology, a newer technology, was
used in the manufacturing of these patches and infrared (heat)
waves from body heat are utilized to stimulate an acupuncture
point, which modifies pain perception and reduces pain to half
or less. Medically this would be considered an excellent pain
reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the
US a 5 pack of the IceWave spray is available that can be directly
sprayed onto the skin in the area where the pain is located.
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