Aperture chest syndrome

Aperture chest syndrome

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Aperture chest syndrome consists of a group of different conditions involving the upper thoracic aperture compression affects the brachial plexus (nerves that pass from the neck to arm) and subclavian artery or vein (blood vessels that move in the upper neck). Compression can be positioned (caused by movement of the arm and collar bone) or static (caused by abnormalities or enlargement of various muscles that surround the arteries, veins and brachial plexus).
Over time as different names depending on the pathophysiological mechanism: scalene syndrome, syndrome costoclavicular, hiperabductie syndrome, cervical rib syndrome, syndrome coast upper thoracic aperture I. syndrome is diagnosed in about 8% of individuals. This disease often involves regional anatomical abnormalities, but in some cases functional modifications are those that produce symptoms in terms of anatomy cvasinormale. Superior thoracic aperture communication represents the region cervico-thoracic anatomy. Unlike the lower aperture whose size varies continuously with the upper chest breathing aperture size is fixed.
Neurogenic form of the syndrome consists of over 95% of cases. It is known from studies on cadavers and surgical patients affected as there are numerous anomalies scalene muscles and other muscles that surround arteries, veins and brachial plexus. The syndrome may result from these abnormalities or scalene muscle hypertrophy. Hypertrophy is a common cause of trauma that can occur in road collisions.
The two groups of people who are prone to develop this syndrome are those who suffer from traumatic neck injuries or who use computers in non-ergonomic position for long periods of time. Other groups which are rarely syndrome can develop athletes who raise arms overhead frequently, and some musicians.
Adson sign and menevra costoclaviculara are vague and not themselves lead to the identification sidnromului. There are no clinical signs that make the diagnosis. Arteriography may be used if surgery is planned to correct an aperture artery syndrome. Additional maneuvers that may be abnormal include raising hands (keep both his hand above his head, tomorrow will be more affected than the unaffected pale compromise because the contribution of blood) and compression test (the pressure of the medial clavicle and humeral head irradiation cause pain / numbness in the affected limb ).
Physical therapy, acupuncture or massage may be enough to treat the syndrome. However during the recovery process is a few days and take a position poor patient recall symptoms. Approximately 10% of patients suffer decompression surgery after failed conservative treatment, usually tested between 6 and 12 weeks. Surgical treatment may include removal of abnormal muscle, removal of scalene muscles, the ribs or if Aprime is the presence of a cervical rib or neuroliza (removal of fibrous tissue in the brachial plexus).
Pathogenesis and causes:
The central element in the aperture chest syndrome is coast I, vascular structures, nerve compression is achieved by neighboring elements on the coast I, normal or not structural. During abduction maneuvers of the arm is rotated to the back collar and compresses the subclavian vessels and scalene I previously coast. In hiperabductie bunch vasculonevos is practically lying on the humeral head, the small pectoral tendon and coracoid process. Descent sterno-clavicular shoulder uncle close by Descent clavicle in I. Coast scalene deep inspiration before I can rise excessively when the coast is hypertrophied scalene or severe emphysema, as costoclavicular space is much narrower. Bone abnormalities are present in 10-30% of patients. Venous compression leads to edema, venous distension, cyanosis. Compression pressure causes pain, no pulse, claudication, trophic changes. Nerve compression leads to pain, numbness, muscle weakness, Raynaud's phenomenon.
Etiologic factors may be involved in the development of superior thoracic aperture sidnromului cunt: Congenital factors: Cervical rib, articulated or not I coast, about 0. 5% of people have cervical rib, often bilateral, is more common in women left Enlarged C7 transverse-process I rudimentary adherence to-coast II coast CI-CII-synostosis intercostal I-exostoza coast -Cost and more flattened with increased Lisfranc tubercle Flat-clavicle, collarbone bifida Previously scalene insertion double-coast I inserted the middle scalene aberrant coast I Currently small-scalene in 10% of cases the brachial plexus separates the subclavian artery, sometimes with atrophy of its fibrous form of Sibson fascia Subclavian hypertrophied-muscle hypertrophy, breast, breast implants.
Traumatic factors: Clavicle fracture consolidation, with breech, dislocations of the humerus subacromiale Upper-thoracic trauma, sudden intense muscular effort of the Center = hatred scapular -Cervical-exostoze.
Postural factors: Cifoscolioze-cervico-thoracic scoliosis and -Scalene hypertrophy by carat weights in hands.
Types of upper chest syndrome aperturta depending on the cause of symptoms: -Neurogenic components produced by brachial plexus compression Artery-subclavian artery compression caused by -Venous subclavian vein caused by compression. Neurogenic form include 95% of cases.