Syndrome of the thoracic inlet
VASCULAR SURGERY – EURODOCTOR.RU – 2007
The upper aperture of the chest – a small space, limited the clavicle and first rib. Through this hole to the upper extremity are a lot of blood vessels, nerves and muscles. Under certain conditions (compression of the rib, clavicle, or muscle), this space is narrowed, leading to compression of these structures. So there's syndrome thoracic inlet (VAGK).
Depending on whether VAGK compressed nerves, arteries or veins of the disease is manifested in a variety of symptoms. 95% of the cases of the syndrome associated with compression of VAGK nerves. In 3-4% of cases, the syndrome occurs VAGK compression of the veins – blood vessels that carry blood flowing from the upper extremity to the heart. In this vein at the site of compression of the blood clot is formed, what happens cause of pain and swelling in his hand. The remaining 1-2% of the manifestations of the syndrome VAGK account for compression of the arteries. Prolonged compression of the large arteries of the upper limb is also fraught with the formation of thrombi in their lumen, and further spread by the hands of the vessels, which tends to ischemia and necrosis (gangrene).
As shown VAGK syndrome?
Symptoms of the disease depend on the fact that compressed – nerve or vessel? More often than not affect the compression of a single component, but several, which leads to a variety of symptoms. The most common signs of this disease are swelling of the hands, weakness in the hand or wrist, as well as fatigue in his hand, which is enhanced by raising the arms above the head. In addition to these symptoms may be a tingling or numbness in the hand due to compression of the nerve. In addition, marked pain in the upper extremity, from the shoulder and ending with your fingertips. Unfortunately, the manifestations of the syndrome VAGK often vague and nonspecific.
What are the causes of the syndrome VAGK?
Most often, this additional edge (called a cervical rib), a fractured collarbone and first rib, or for example, dangling arm because of the weakness of muscle tone. These reasons are sometimes contribute to a narrowing of the thoracic inlet. VAGK syndrome occurs in young patients, especially if their work involves repetitive hand movements. In this case, the reason lies in the fact that under such movement of the arm takes place pressure on the first edge of the clavicle, which leads to a narrowing of the thoracic inlet. In rare cases, when certain invasive interventions or diagnostic procedures such as angioplasty or after the installation of artificial pacemaker (pacemaker) in the lumen of the vessel clots are formed, which in turn contribute to the development VAGK syndrome.
Methods for diagnosing the syndrome VAGK
Diagnosis of the syndrome of the upper thoracic inlet is difficult because symptoms of this disorder, characterized, and many other diseases of blood vessels or the nervous system (eg, low back pain or Raynaud's syndrome). At the beginning of the doctor asks the patient about the complaints, their nature, what has caused their appearance. After this survey is conducted. It includes the definition of range of motion in arm and shoulder. In addition, a so-called method of Edson. It lies in the fact that the patient raises his hand to the top, a doctor at the same time measures the radial pulse at the wrist. The syndrome of the upper thoracic aperture artery pulsation disappears. However, this test is often positive and healthy people.
To clarify the diagnosis syndrome VAGK the following techniques:
- Radiography of the neck or shoulder
- Doppler ultrasound
- Study of nerve conduction
- Computed tomography
- Magnetic resonance imaging
- Phlebography or arteriography
Treatment of the syndrome of the upper thoracic inlet
Treatment VAGK syndrome depends on the cause of it, and from the symptoms. For example, if the underlying cause of vascular compression of the upper limb is an additional edge, then the doctor will recommend at first to cure this cause.
In other cases, treatment begins with exercises designed to strengthen the muscles are not of the thoracic inlet. Typically, such exercises are recommended to strengthen the muscles of the shoulder girdle, which reduces pressure on the nerves and blood vessels of the upper extremity.
Your doctor may prescribe administration of drugs such as muscle relaxants, nonsteroidal anti-inflammatory drugs (aspirin or ibuprofen), pain relievers or steroid hormones. In addition, using heat treatments and massages the affected area.
In the early stages of the disease, many patients after these events mark an improvement. However, if after conservative treatment effect was not observed, it is recommended to have surgery.
These include decompression of the thoracic inlet, which is to remove the additional edges (if the cause of the disease was in it) or the first rib, which extends the space of the thoracic inlet. In addition, the surgeon may cut some small muscles that attach to the first rib, as well as scar tissue that compresses the nerves. Sometimes it takes a combination of these techniques.
In the case of blockage hand vein thrombus, the surgeon may attempt to destroy a blood clot through the introduction of a special substance, dissolving the clot. This procedure is called thrombolysis.
With significant damage to the arteries of the upper extremity during a prolonged compression syndrome VAGK surgeon may suggest methods of recovery, such as bypass surgery. Usually this is taken from the Vienna subcutaneous thigh area. The site selected in such a way the veins at one end stitched to the artery above the narrowing, and the other end – a place of constriction. This procedure restores blood flow.
Another method of restoring blood flow in arteries is angioplasty combined with stenting. This is a minimally invasive method. It lies in the fact that through the femoral artery catheter with the inflated balloon on the end. The catheter is brought to the site of constriction. This process is controlled in real time on a special monitor. Once the catheter is in place narrowing of the arteries, balloon is inflated and the restriction of the site expands. Sometimes this site is strengthened artery stent – a cylindrical wire, which plays the role of the framework.
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