THORACIC-OUTLET-OBSTRUCTION SYNDROME (Cervical-Rib Syndrome; Serratus Anticus Syndrome) |
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General Information
DEFINITION--Pain and weakness from compression of nerves in the neck. These nerves affect the shoulders, arms and hands.
SIGNS & SYMPTOMSOne or more of the following:
Pain, numbness and tingling in the neck, shoulders, arms and hands.
Weakness in the arms and fingers.
Absent pulse in the wrist when raising the arm and turning the head toward the opposite shoulder, if symptoms are caused by a cervical rib.
CAUSES & RISK FACTORSThe nerves and blood vessels that supply the shoulder, arms and hands start in the neck and pass as a bundle near the cervical ribs and collarbone. Pressure on this nerve and blood-vessel bundle creates symptoms. Pressure may be caused by:
An extra rib in the lower neck (cervical rib).
Overdevelopment of neck muscles, as may be required with some contact sports or may result from overzealous weight-lifting programs.
Prolonged period with the arm or neck in an abnormal position, as can occur during surgery, during unconsciousness for any reason, or while sleeping with a too-firm object under the neck.
Injury from overextending the arm or shoulder.
Tumor that has spread to the head and neck area from another part of the body.
Muscle weakness and drooping in the shoulder.
HOW TO PREVENT
Avoid shoulder and neck injury whenever possible. Wear seat belts and use padded headrests in cars. Use shoulder pads or other protective equipment appropriate for your sport.
Don't use mind-altering drugs or drink excessive amounts of alcohol, which can lead to unconsciousness.
Change sleeping positions. Try sleeping on one side or sleep without a firm pillow.
If symptoms are caused from overdeveloped muscles in the neck, reduce neck-muscle-building exercises.
WHAT TO EXPECT
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the neck and shoulder area to look for an extra cervical rib or tumor.
SURGERYSometimes necessary if a cervical rib is causing pressure on nerves and blood vessels.
NORMAL COURSE OF ILLNESS
If caused by overdevelopment of neck muscles, the disorder is usually curable with physical therapy and decreased neck-muscle exercises.
If caused by injury while unconscious or asleep, the disorder is usually curable with retrained sleeping habits and physical therapy.
If caused by a cervical rib, the disorder is usually curable with surgery.
If caused by a tumor, treatment may be unsuccessful.
POSSIBLE COMPLICATIONS
Permanent numbness or loss of arm or hand strength if thoracic-outlet-obstruction syndrome is not treated.
Post-surgical complications (rare).
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
MEDICAL TREATMENT
Doctor's treatment.
Surgery to relieve pressure on the nerves and blood vessels if a cervical rib is the underlying cause.
Physical therapy.
HOME TREATMENTUse heat to relieve pain. Use a heating pad, heat lamp, hot showers or warm compresses.
MEDICATIONYou may use non-prescription drugs, such as acetaminophen or aspirin, to relieve pain. Medication cannot correct the underlying condition.
ACTIVITYYour doctor may prescribe physical therapy and exercises less likely to cause neck-muscle overdevelopment.
DIETNo special diet.
CALL YOUR DOCTOR IF
You have symptoms of thoracic-outlet-obstruction syndrome.
Symptoms don't improve in 2 weeks, despite treatment.
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