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Thoracic outlet syndrome

Thoracic outlet syndrome is a controversial issue in terms of surgical treatment. Complaints and symptoms occur as a result of entrapment of the vessels and nerves feeding the arm and hand at the chest level.


Pressure on nerves and vessels occurs due to reasons such as angle changes between the collarbone and first rib, congenital abnormalities or traumatic narrowing, fractures, ballooning of the great vessel and lung tumors, and extra ribs in the neck.  


It is more common in the 20-40 age group and the male-female ratio is 4/1. Pain and numbness occur in the arm, ring and little fingers during hair drying, heavy lifting and movements while taking items from high shelves. Loss of strength and muscle wasting may rarely occur.


Nerve electrical tests, EMG and other examinations are usually normal. Direct radiographic examinations and angiography are important in diagnosis and differential diagnosis. Diagnosis is mostly made by examination.


Conservative treatment is considered first. Removal from movements and positions that cause an increase in complaints and symptoms, and physical therapy are important in this step. Surgical treatment may be considered in cases with inadequate conservative treatment, persistent pain, significant neurological defects and progressive vascular problems. However, surgical treatment results may not always guarantee the expected result.

Tense bands or scalene muscles that compress the nerves are usually blamed for the cause. In the treatment, surgical cutting of the accused tape and relaxation of the muscles are performed.

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