Steemit Learning Challenge-S22W6; Thoracic Outlet Syndrome

Edit by PixelLab

Steemit friends, may we always be in good health. Glad to be back at the last learning in week 6 after ending the previous week. The new theme organized this time is Steemit Learning Challenge-S22W6; Thoracic Outlet Syndrome. In this last participation I remain more enthusiastic even though the previous week's victory was not in my favor, and hopefully in this week there is luck. As the last week I would also like to thank Mrs. @ashkhan for providing lessons for the past 6 weeks.

1. What is thoracic outlet syndrome? Write in your own words after acquiring knowledge from the lesson post. (Note: do not add any special tests or investigations and detailed treatments in this question. Write the answer precisely).

Thoracic outlet syndrome is a condition experienced by a person that occurs due to pressure on the nerves or blood vessels in the area above the chest cavity. This pressure can affect the nerves in the brachial plexus that control hand and arm movement, the scalenus muscle in the neck and the subclavian artery and vein as blood flow to the neck, shoulder and chest. It is often associated with structural abnormalities such as additional ribs or unusual bone shape. This condition is known by many other names as it depends on the location and type of pressure, such as First Thoracic Rib Syndrome or cervical Rib Syndrome. And will cause symptoms of pain, tingling, or impaired blood flow in the affected area.

The common causes that often occur are as follows:

Common causes of thoracic outlet syndrome, which is shortened to (TOS), include various factors that can compress blood vessels or nerves in the neck and shoulders. Work activities that involve various movements that raise the hands above the head with heavy loads and repetitive arm movements are often the triggers. And poor posture, such as the common practice of raising the hands above the head, also increases the risk. Then acute injury or what is called trauma, including whiplash injuries that are common due to traffic accidents due to hyperflexion or hyperextension of the neck, now this is another factor that is often related. Then certain sports activities, such as playing baseball, playing volleyball, and swimming, which can cause pressure on the area. Next is a history of injuries similar to those experienced in the past that have reoccurred, as well as the cause, trauma if accompanied by compression of the structures around the neck and shoulder.

Symptoms

There are several common symptoms that occur in thoracic outlet syndrome (TOS), which can be divided into two main categories, vascular symptoms and neuropathic symptoms. Here is my explanation of the vascular symptoms:

• The color of the hands will change, the patient's hands will appear bluish or on the arms due to impaired blood flow, especially when the patient does overhead activities.

• The patient feels a sensation of cold and heaviness, where the arms and hands feel heavy and cold during exercise and the blood supply to the extremities is disrupted.

• The patient may experience throbbing pain in the chest, neck, arms or hands.

• Patients will experience swelling that sometimes appears in the armpit, collarbone, arm or hand.

• Patients will feel weakness and fatigue in the upper arm area which often feels tired.

Furthermore, common symptoms in thoracic outlet syndrome in the neuropathic category:

• The patient will feel a tingling sensation and numbness more often on the medial part of the arm, and the little finger will be traumatized. Symptoms like this include the ulnar nerve distribution pattern and are often exacerbated by certain positions, for example when the patient raises the arm above the head.

• The patient will experience Atrophy which is called muscle shrinkage, here the patient will experience a more severe case, especially in the small muscles in the hand and in the thumb and other fingers will shrink. This will make it more difficult for the patient to perform light activations, such as typing, fastening clothes, and picking up small objects....

• The patient will feel pain along the ulnar nerve pathway, the pain will start from the inside of the upper arm, pass through the elbow to the ring finger and be felt by the little finger. This pain is very sharp as it will stab the patient or feel like a burning sensation, but also depends on the pressure that occurs on the nerve.

Based on the associated structures, so I will give three types of Thoracic Outlet Syndrome, here are three types of TOS:

1. Vascular TOS
   Vascular TOS involves the disruption of the blood vessels, such as the subclavian arteries and veins, which are responsible for delivering blood to the neck, arms and hands. In general, the symptoms are more related to blood flow disorders, such as swelling, discoloration or cold sensation in the upper extremities.

2. Neurogenic Tos
   This test is caused by nerve compression in the brachial plexus, which belongs to the ulnar nerve and other nerves. The symptoms that often arise here change numbness, muscle weakness, tingling or pain in the shoulder area, arms, armpits to the hands. This type is classified as the Top that often occurs.

3. Mixed Tops
   Mixed top includes a combination and compression of blood vessels and nerves. These symptoms are a combination of Neurogenic and vascular Tops, causing the victim to experience tingling sensations and impaired blood flow to pain due to nerve compression.

Diagnosis

Diagnosis of Thoracic Outlet Syndrome will be done with several methods to be able to find out more clearly what causes it and how severe the condition is. The following are some of the most common steps:

• Anamnesis
  Medical personnel will collect all family history to obtain information, such as work history, past medical history, and the patient's surgical history in order to determine the risk factors or triggers of TOS.

• Physical examination
  The doctor or physical therapist will evaluate symptoms such as weakness or circulation changes, pain. This will usually include specialized tests to detect pressure on blood vessels or nerve structures.

• Medical imaging
  These tests will be performed using X-rays, ultrasound and magnetic resonance imaging (MRI), and will assess bone conditions, tendon ruptures, joint strain or muscle damage often associated with TOS.

• Electrovisiology test
  Eloctromyography and nerve conduction studies are used to evaluate nerve damage and measure the level of muscle strength. These tests can confirm the difference of TOS from other nerve causes.

There are three specific tests performed to diagnose thoracic outlet syndrome (TOS):

1.Adson maneuver

The doctor will perform this test on the patient in an upright sitting condition, the patient's arms are at the sides of the body, and the head is facing forward. As an initial step, the doctor will perform therapy on the patient to determine blood pressure. The doctor asks the patient to turn the head towards the side being tested while extending the head and neck. Furthermore, to be able to show the presence of neurovascular compression, the patient must take a deep breath or hold it for several minutes. If after doing so symptoms such as numbness, pain reappear or tingling, the results are still considered positive and true neurovascular compression.

2.Halstead maneuver

In this test, the patient is asked to sit quietly while the therapist measures the radial pulse to determine the initial rhythm. The patient's head is then turned in the opposite direction of the side being tested, while the therapist applies downward pressure on the involved arm. If the radial pulse weakens or disappears during the maneuver, the result is positive, indicating true vascular compression of the TOS.

3.Allen or Wright test

This test is performed on a seated patient. The patient's shoulder joint is lifted maximally to the side. The therapist will check for changes in limb temperature, radial pulse and skin color. The test result will be positive if the pulse becomes irregular or there are other symptoms, such as uncomfortable sensations or changes in skin color. Then the test is correct for impaired blood flow in the affected area.

2. How do you diagnose thoracic outlet syndrome? Any clinical investigations or assessment tests? (Do not add treatment to this question)

To diagnose thoracic outlet syndrome (TOS), it is sufficient to do so with a simple method through several systematic steps. To be able to understand the patient's medical history, the doctor will primarily take anamnesis which also includes symptoms of tingling, pain, and weakness in the hands and arms. Then to determine muscle strength, swelling or discoloration of the skin, and reflexes, the medical staff will conduct a thorough physical examination.

There are also special clinical tests such as the Adson maneuver, Halstead maneuver and Wright test that are often performed. These tests involve changing the position of the neck, head and arms to determine compression of the nerves or blood vessels. If symptoms or changes in the radial pulse appear in this test, the result is positive.

Finally, there are imaging investigations such as MRI, or ultrasound, X-rays that help in detecting abnormalities in bone structure, soft tissue or blood vessels. In evaluating nerve function and to differentiate TOS from similar conditions, electrophysiologic tests such as Electromyography (EMG) and Nerve conduction study (NCS) will be performed. All these tests can help to accurately determine the diagnosis of TOS.

3. Try to practice at least 3 exercises that you have learned from the lesson. Share a picture, gif, or video of you practicing, preferably a gif or video.

• Shoulder Shrugs