The chest consists of vertebrae, ribs and sternum. There are special openings called apertures. It is through them that the nerves and blood vessels pass. There are two in the chest: the upper and lower apertures. The first is formed using the clavicle, the first rib, muscles and thoracic vertebra.
Such a structure is considered anatomically important. Thanks to him, all functions are carried out as accurately as possible. This structure provides the work of the lungs, blood vessels, nerves, as well as other organs that are nearby.
Sometimes those joints that pass through the hole can get pinched. It is because of this that the syndrome of the upper aperture of the chest occurs.
Reasons for the appearance
As already mentioned, the syndrome appears due to the fact that a person has a clamped neurovascular node. Damage can be caused by various reasons. For example, a person sits too long or, conversely, is physically active. The provoking factors include fracture of the ribs, clavicles, displacement of the vertebrae.
Some patients experience nerve compression. This happens due to narrowing of the nerve fiber. In this case, the disease has vivid symptoms.
Infringement of the venous and arterial type is quite rare. The cause of the syndrome of the upper aperture of the chest of this type is considered not only normal compression, but also thrombosis.
If the doctor does not intervene on time, serious consequences can occur.
Symptoms
How exactly the pathology manifests itself, and how much the symptoms are noticeable, completely depends on what structure was impaired. If a nerve is pinched, then there will be a feeling of numbness of the limb, tingling, impaired sensation, pain, problems with the micromotorism of the fingers and generally with the movement of the hand. Fatigue will appear.
Symptoms of the syndrome of the upper aperture of the chest vascular type are quite severe. Such a pathology occurs rarely, but brings more discomfort. For example, a hand may swell, a strong pain effect will occur, numbness, and pressure will rise.
If the patient has arterial compression, then the hand will lose sensitivity, leading to severe pain, as well as cyanosis. In the event that the patient is not quickly helped, he will have tissue necrosis and various ischemic changes.
Diagnostics
Unfortunately, the diagnosis of the upper chest aperture syndrome, the causes of which are already described above, is quite complicated. This is due to the fact that all the symptoms are inherent in other vascular, nervous diseases.
First, the doctor must find out all the nuances of the symptoms, how strong and lasting they are, and then conduct a comprehensive examination. It is imperative to conduct a study that will allow you to understand how much movement the arm and shoulder are capable of making. Edson's technique is also used. The patient should raise his hand as high as possible. The doctor at the same time on the radial artery measures the pulse near the wrist. If we are talking about the presence of upper chest aperture syndrome, then pulsation will be absent.
In order to clarify the diagnosis, an X-ray of the neck or shoulder, an ultrasound scan should be performed, and the state of the nerves and blood vessels should be checked. For the latter, computed tomography and magnetic resonance types are used. Phlebography is also sometimes prescribed.
Syndrome treatment
Treatment of the syndrome of the upper aperture of the chest completely depends on what its causes are and how severe the symptoms are. If the vessels are compressed due to an additional rib, then it is advisable to first eliminate the cause.
In other cases, experts recommend exercising. This will strengthen the muscles in the upper aperture. To reduce pressure on the affected vessels and nerves, it is advisable to do exercises designed to train the shoulder joint.
Sometimes the doctor prescribes medications that will reduce symptoms. It can be painkillers (for example, Ibuprofen or Aspirin), anti-inflammatory drugs, muscle relaxants.
Massages and other thermal treatments are prescribed. If the disease is at an early stage, then all of the above methods will alleviate the condition of the patient. If the methods did not help, then proceed to the operation.
Surgical intervention
If the cause of the syndrome of the upper aperture of the chest is the additional or first rib, then it is removed. This will expand the space for blood vessels and nerves, respectively, and infringement is eliminated. Also, with certain indications, small muscles that attach to the ribs can be dissected.
In the event that the cause is the appearance of a blood clot in a vein, a special procedure is performed - thrombolysis. It is carried out using a special substance that is injected into a vein. It should destroy the resulting blood clot.
If the situation is severely neglected and the clamped artery begins to collapse, then the surgeon may try to recover it. Shunting is performed. For a successful procedure, a saphenous vein is used, which is located on the thigh. Vascular pathways are sutured. Through this procedure, blood flow is restored.
An excellent method for restoring the normal functioning of an artery is angioplasty, which is performed with stenting. This method involves the insertion of a catheter with a balloon at the end. It should pass through the femoral artery. Next, the doctor should bring the catheter to the site of narrowing of the artery. When the can begins to inflate, the infringed area increases. To ensure the operation of the artery, a cylinder-shaped wire can be installed. She will be the frame.
Compression syndrome
Compression syndrome of the upper chest aperture is considered a neurological disease that causes pain in the arm, neck, shoulders or hands. Unpleasant sensations are provoked by the infringement of the brachial plexus and the adjacent vessels. There are no specific diagnostic methods. In the treatment of analgesics, as well as physiotherapy. In severe cases, the doctor may insist on an operation that will restore the functioning of blood vessels and nerves.