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Compression syndromes of the upper chest aperture
Last reviewed: 23.04.2024
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Compression syndromes of the upper aperture of the chest are an indistinct group of neurological diseases characterized by pain and paresthesias in the hands, neck, shoulders or arms. It is believed that the pathological process is characterized by compression of the lower trunk of the brachial plexus (and, probably, subclavian vessels) where they pass under the stair muscles over the 1st rib. There are no specific diagnostic methods. Treatment includes physiotherapy, analgesics, in severe cases - surgical intervention.
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Pathogenesis
Symptoms of the compression syndromes of the upper chest aperture
Pain and paresthesia usually begin in the neck or shoulder, extend to the medial part of the hand and the wrist, and sometimes to the adjacent front wall of the chest. Often, on the side of pain, there is a mild - moderate sensitivity disorder at the C7 - Th2 level, sometimes - pronounced vascular vegetative changes on the hands (for example, cyanosis, swelling). Sometimes there is weakness in the affected hand. Among rare complications, Raynaud's syndrome and distal gangrene.
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Diagnostics of the compression syndromes of the upper chest aperture
The diagnosis is based on the nature of the distribution of symptoms. To demonstrate the compression of the vascular structures, various methods have been suggested (for example, the tension of the brachial plexus), but their sensitivity and specificity have not been established. Auscultation reveals vascular noise above the clavicle or in the axillary region, radiography can reveal a cervical rib. Angiography is able to detect inflection or partial obstruction of the axillary arteries or veins, but no result is an unequivocal proof of the disease. Contradictory and other diagnostic methods. As with brachial plexopathy, an introductory study (eg, electrodiagnostics and MRI) is justified.
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Treatment of the compression syndromes of the upper chest aperture
In most cases, patients without objective neurological defects respond well to physiotherapy, NSAIDs and low doses of tricyclic antidepressants.
In the presence of the cervical rib or obstruction of the subclavian artery, the question of surgical treatment should be solved by an experienced specialist. With rare exceptions, the operation is indicated for significant or progressive neurovascular disorders, as well as in cases that are resistant to conservative therapy.