Medifocus Guidebook on Thoracic Outlet Syndrome

A Comprehensive Patient Guide to Symptoms, Treatment, Research, and Support
 

 
Updated: July 24, 2016
102 Pages

 
 

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome is a complex disorder characterized by a constellation of signs and symptoms resulting from the compression of blood vessels and nerves (neurovascular bundle) in the thoracic outlet region where they exit the chest. The thoracic outlet is a space located between the thorax (rib cage) and the clavicle (collar bone) which contains major blood vessels (subclavian artery and vein) and nerves (brachial plexus). The thoracic outlet is the area through which nerves and blood vessels travel to and from the arm.

Thoracic outlet syndrome is considered a "syndrome" since it involves multiple systems, including:

  • Neural (nerve) complexes
  • Vascular structures
  • Musculoskeletal system

Neural Complex

The nerves that travel through the thoracic outlet originate at the level of the cervical and/or thoracic spine (C5-C8 and T1). These nerves are bundled together into the brachial plexus. The brachial plexus passes through a notch in the bone at the base of the neck and then passes under the scalene muscles and continues under the collarbone and across the front of the shoulders. In the area of the axilla (arm pit) the brachial plexus divides into the three major nerves of the arm, ulnar, median, and radial nerves. Thoracic outlet syndrome involves the brachial plexus before it divides and typically affects the ulnar and radial nerves.

Vascular Structures

The blood vessels that travel through the thoracic outlet include:

  • Subclavian artery which supplies oxygenated blood to the arm from the aorta
  • Subclavian vein which returns the deoxygenated blood from the arm to the heart

Musculoskeletal System

The bones and muscles form the backdrop for proper passage and support for the nerves and blood vessels that traverse the upper body. The components involved in this process include:

  • Proper bone alignment - the neck vertebrae, first rib and collarbone must be aligned properly to allow enough space for the brachial plexus and subclavian blood vessels to pass through the correct path without obstruction or interference.

  • Proper muscle alignment - muscles of the upper body must be aligned in proper form, particularly the scalene muscles. The scalene muscles consist of three powerful muscles on each side of the neck that bend and rotate the neck, and assist in breathing by raising the first two ribs during inspiration (breathing in). The ideal posture which promotes the most appropriate muscle alignment is when the head sits directly atop the shoulders which we identify as erect posture.

Anatomy of the Thoracic Outlet

There are actually three spaces where compression can occur causing the symptoms of thoracic outlet syndrome , including:

  • The thoracic outlet (also called the scalene triangle) - is located at the base of the neck above the first rib and behind the clavicle. This space lies closest to the neck. The boundaries of the thoracic outlet consist of:

    • anterior scalene muscle which forms the front of the thoracic outlet
    • middle scalene muscle which forms the back of the thoracic outlet
    • first rib which forms the bottom of the thoracic outlet.

The subclavian artery and the brachial plexus are located between the first rib and the scalene muscle while the subclavian vein sits outside the scalene muscle.

  • Costoclavicular space - this space is located adjacent to the scalene triangle and lies between the following structures:

    • clavicle
    • first rib
    • costoclavicular ligament
    • edge of the middle scalene muscle

The subclavian artery, vein, and brachial plexus all pass through the costoclavicular space.

  • Subcoracoid space which lies adjacent to the costoclavicular space and is closest to the arm. The location of this space is:

    • under the pectoralis muscle
    • under the coracoid process
    • in front of the ribs

If there are any anomalous bony structures (e.g., cervical rib) touching upon these small spaces, they have the potential to compress the neurovascular structures which pass through them. Approximately 0.17 to 0.74% of the general population has an anomalous rib and only 10% of people with such a cervical rib actually develop thoracic outlet syndrome. Thoracic outlet syndrome typically occurs following trauma to the cervical spine.

Because thoracic outlet syndrome is thought by some experts to be underdiagnosed and in some cases misdiagnosed, it is difficult to estimate with any degree of accuracy how many people suffer from this condition. The incidence of thoracic outlet syndrome in the U.S. population has been broadly estimated to range from 0.3% to 8%. The most common age range is 25 to 40 years and women are affected about 4 times more frequently than men.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Thoracic Outlet Syndrome

If you or a loved one has been diagnosed with thoracic outlet syndrome, it's critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That's why we created the Medifocus Guidebook on Thoracic Outlet Syndrome, a comprehensive 102 page patient Guidebook that contains vital information about thoracic outlet syndrome that you won't find anywhere in a single source.

The Medifocus Guidebook on Thoracic Outlet Syndrome starts out with a detailed overview of the condition and quickly imparts fundamentally important information about thoracic outlet syndrome, including:

  • The theories regarding the underlying causes of thoracic outlet syndrome.
  • The risk factors that can increase a person's chances for developing thoracic outlet syndrome.
  • A detailed overview of the three major types of thoracic outlet syndrome, which include:

    • Neurogenic thoracic outlet syndrome
    • Vascular thoracic outlet syndrome
    • Neurovascular thoracic outlet syndrome
  • The signs and symptoms of thoracic outlet syndrome.

  • How thoracic outlet syndrome is diagnosed based on factors such as signs/symptoms, patient history, physical examination, provocative compression maneuvers, and imaging studies. *Other underlying medical conditions that may be confused with thoracic outlet syndrome and must be considered in the differential diagnosis of thoracic outlet syndrome.

Understanding the Standard Treatments... and the Treatment Options

The goals of treatment for patients with thoracic outlet syndrome include:

  • Relieving compression of the nerves and/or blood vessels in the thoracic outlet region.
  • Controlling and minimizing pain and other symptoms associated with thoracic outlet syndrome.
  • Enabling patients to continue to function and lead a reasonably good quality of life.

Understanding the standard treatments - and the treatment options - is critical for successfully achieving the goals of treatment for thoracic outlet syndrome. As you read through the section of the Guidebook that focuses on the treatments for thoracic outlet syndrome, you will specifically learn about:

  • The role of conservative treatments as the first-line approach for the treatment of thoracic outlet syndrome, including:

    • Physical therapy
    • Ultrasound therapy
    • Transcutaneous electrical nerve stimulation (TENS)
    • Postural training
  • The medications that may be prescribed to control pain in patients with thoracic outlet syndrome, including:

    • Analgesics
    • Muscle relaxants
    • Antidepressants
    • Anticonvulsants
    • Nerve blocks
  • The surgical treatment options that are currently available for the management of thoracic outlet syndrome, which include:

    • Transaxillary first rib resection
    • Cervical scalenectomy
    • Resection of fibrous bands
  • The treatment options that are currently available for the management of vascular thoracic outlet syndrome.

  • The role of lifestyle modifications in helping patients to better control the symptoms of thoracic outlet syndrome.
  • Quality of life issues that often confront people with thoracic outlet syndrome and how to minimize their impact and cope better with these issues.
  • Important questions to ask your doctor about thoracic outlet syndrome.

A "One-of-a-Kind" Reference Guidebook on Thoracic Outlet Syndrome that Goes Way Beyond the Fundamentals

Since 1996, when Medifocus was founded, we've learned that many people with Thoracic Outlet Syndrome are seeking more specific information that goes beyond the fundamentals, such as the causes, diagnosis, standard treatments, and treatment options. That's why we developed a "one-of-a-kind" reference Guidebook that goes way beyond the basics and also includes the following sections:

  • A Guide to Recent Medical Literature on Thoracic Outlet Syndrome - This section of the Guidebook contains an extensive bibliography of over 100 references to recently published articles about Thoracic Outlet Syndrome in authoritative, peer-reviewed medical journals with links to the absracts (summaries) of the articles. These articles represent the latest advances in the field and focus on cutting-edge research, new developments, and the lessons learned from recently published clinical trials involving patients with Thoracic Outlet Syndrome. This is the same level of that is used by doctors who treat people with Thoracic Outlet Syndrome to keep abreast of the latest developments and breakthroughs in this specialized field of medicine.

  • Centers of Research for Thoracic Outlet Syndrome - We've compiled a unique directory of doctors, hospitals, medical centers, and research institutions with special interest and, in many cases, clinical expertise in managing people with Thoracic Outlet Syndrome. The "Centers of Research" directory is a valuable resource for quickly identifying and locating leading medical authorities and medical institutions both within the United States and other countries who are considered to be at the forefront in clinical research and treatment of Thoracic Outlet Syndrome. You'd have to spend days - or even weeks - attempting to compile your own list of doctors and medical centers but, with the "Centers of Research" directory, the information is already right at your fingertips. All you have to do is act on the information by selecting and contacting the experts or medical institutions listed in the directory by state and country.

  • Organizations and Support Groups for Thoracic Outlet Syndrome - The Guidebook also includes a directory of organizations and support groups whose goal is to help people with Thoracic Outlet Syndrome by providing access to information, resources, and services. Many of these organizations can answer your specific questions, enable you to "network" with other patients, and provide guidance in areas such as financial, social, or medical-legal issues. This valuable directory of organizations and support groups includes complete contact information, including phone numbers and E-mail addresses.

Look Inside the Guidebook

The Guidebook is a Value-Added Proposition that Comes with a Risk-Free Satisfaction Guarantee so that...You have Nothing to Lose and Everything to Gain

Still not sure if you'll benefit from the Medifocus Guidebook on Thoracic Outlet Syndrome? Still not convinced that the information included in the Guidebook is worth the minimal cost? If that's the case, then please consider the following value-added proposition that comes standard with your purchase of the Guidebook:

  • Free Updates for One Year - With your initial purchase of the Guidebook, you also receive access to free updates for one-full year. The Guidebook is updated with new information every 4 to 6 months, so that you will be able to access the updated information several times during the course of a year for up to one full year after the date of your initial purchase.

  • Free Digest E-Mail Alerts - When you purchase the Guidebook, you will also automatically receive a free subscription to our monthly newsletter - the Medifocus Digest Alert for Thoracic Outlet Syndrome. This is an expertly selected listing of the latest articles published in the medical literature about Thoracic Outlet Syndrome with convenient links to the abstracts of the articles that focus on cutting-edge research, clinical trials, and the latest treatment advances. The Medifocus Digest Alert for Thoracic Outlet Syndrome is automatically delivered straight to your "inbox" monthly and is a valuable resource for keeping up with the latest developments in Thoracic Outlet Syndrome almost as soon as the new information is published in the medical literature.

  • 20% Discount - For a limited time, you can purchase the Medifocus Guidebook on Thoracic Outlet Syndrome at a special 20% discount off the regular list price. Your 20% discount will automatically be applied when you go to "Checkout".

  • Risk-Free Satisfaction Guarantee - Your purchase comes with our RISK-FREE satisfaction guarantee. If, for whatever reason, you are not totally satisfied with the content of your Guidebook, simply contact us within 30-days of your purchase for a prompt, full refund. We are so confident that you will be satisfied with your Guidebook that we offer this RISK-FREE satisfaction guarantee unconditionally - no questions and no hassles.

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Medifocus Guidebook on Thoracic Outlet Syndrome


Updated: July 24, 2016
102 Pages

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What Our Customers Are Saying...

"This MediFocus Guidebook on Thoracic Outlet Syndrome is terrific. In the past I thought that this was a 'hush-hush' topic. Thanks for enlightening all the TOS sufferers out there. This helpful information was sorely needed. It is as though you opened up a door and let some light shine through on this topic."
J.V.
Takoma Park, Maryland


"Iím grateful that I purchased the MediFocus Guidebook on Thoracic Outlet Syndrome because I was able to learn much more about this syndrome, its causes, and treatments than from the various specialists that had been recommended to me. Your Guidebook is a terrific "second opinion" for anyone who needs to learn more about Thoracic Outlet Syndrome."
P.K.F.
San Francisco, California


 
Medifocus Guidebook on Thoracic Outlet Syndrome

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