Description

Upper Thoracic Orifice Syndrome or Thoracic Outlet Syndrome is a set of clinical signs and symptoms that are triggered by compression of the nerves and vessels as they pass over the first thoracic rib and behind the clavicle, in the region of the upper thoracic orifice of the thoracic cage. It is divided into:

• Neurogenic
• Vascular
  
  • Arterial
  • Venous
  • Mixed arteriovenous
• Mixed (neurogenic - vascular)

Epidemiology

The neurogenic type of upper thoracic outlet syndrome is more common in women, while the venous type is more common in men.

Reason

The most likely causes of upper thoracic outlet syndrome are:

• Congenital bone or soft tissue abnormality
• Injury
• Changes in posture
• Psychogenic factors

Pathogenesis

Upper Thoracic Orifice Syndrome occurs due to the influence of either external factors or congenital anatomical deformities that cause it:

• compression and/or irritation of the brachial plexus roots
• compression and/or twisting of the subclavian artery
• compression of the subclavian vein

Symptomatology

Each type of syndrome has its own distinct symptoms.

Thus neurogenic upper thoracic outlet syndrome displays:

• Pain with dermatome distribution (usually in the area of the ulna)
• Parenthesia
• Upper limb weakness/loss of skills
• Pain in the cervix
• Pain located in the occipital region

Arterial-type angiogenic upper thoracic orifice syndrome shows:

• Pain in the distal hand (and rarely in the shoulder and neck)
• Finger ischemia
• Parenthesia
• Coldness and pallor of the upper limb
• Upper limb weakness/loss of skills
• Premature upper limb fatigue

Το φλεβικού τύπου αγγειογενές σύνδρομο άνω θωρακικού στομίου εμφανίζει:

•  The pain increases along the course of the axillary vein
• A feeling of heaviness in the affected upper limb
• Swelling and cyanosis of the arm
• Coldness and pallor of the upper limb
• Stiffness in the fingers
• Parenthesia

All types have symptoms related to the position and movement of the upper limb. In particular, in neurogenic upper thoracic outlet syndrome, symptoms are triggered and worsened during arm elevation and abduction to >90 degrees, during weight bearing and during sleep, and symptoms are also more severe at the end of the day.