What is Costoclavicular Passage?
Costoclavicular passage is a triangular area found between shoulder and the neck more specifically in the thoracic outlet and formed by the clavicle, the first rib and scapula. The neurovascular bundle is present in the space and at high risk of compression.
What is Costoclavicular Syndrome?
Costoclavicular syndrome is also referred as hyper abduction syndrome, scalenus anticus, cervical rib syndrome and thoracic outlet syndrome. The term thoracic outlet syndrome was coined by Peet et al in 1956.
Costoclavicular compression syndrome describes the compression of one or many neurovascular structures, brachial plexus, subclavian artery or vein that crosses the thoracic outlet.
This compression syndrome was first diagnosed in soldiers with heavy loads on their back. These soldiers experienced pain, numbness, paresthesia and fatigue in the arms.
It is common in people who are obese, women with heavy breast and elderly women. It rarely occurs in children.
The thoracic outlet syndrome can be divided into two clinical divisions:
- Vascular thoracic outlet syndrome
- Neurological thoracic outlet syndrome
Most of the cases of thoracic outlet syndrome are of neurological type that includes almost 90-97% of the cases. The vascular thoracic outlet syndrome comprises of only 5 – 10% of the total cases of the syndrome.
What are the Symptoms of Costoclavicular Syndrome?
The symptoms can be mild or severe depending upon the cause of the syndrome. If the symptoms are mild and only due to incorrect posture or any positioning it resolves sooner.
People with costoclavicular syndrome experience the following symptoms:
- Stiffness in neck and shoulder
- Chronic pain in neck, shoulders and arms
- Numbness and tingling sensation (paresthesia) in arms
Symptoms may increase due to strenuous exercise and lifting shopping bags. Symptoms tend to improve by resting and having proper sleep.
What are the Causes of Costoclavicular Compression Syndrome?
There can be several reasons for costoclavicular syndrome.
Some of these are listed below:
- It can be due to the clavicular depression towards or against the first rib. this leads to narrowing of the costoclavicular passage and pushes the scapula forward. This is the reason for costoclavicular syndrome in shoulders of the soldiers.
- In obese people and middle aged women a tight subclavius can also cause compression syndrome.
- Wearing very tight brassiere straps that is supporting very heavy breasts in elderly women can also cause this problem.
- The first rib may also bend towards or against claviceps and causes difficulty in breathing.
- Poor posture can also lead to such syndrome.
- Any accident related to shoulder or neck also causes spasm in cervical muscle that leads to costoclavicular syndrome.
How can Costoclavicular Compression Syndrome be Diagnosed?
There are various methods to diagnose the disease but the clinical diagnosis is difficult. The physician looks for some signs and severity of pain.
Following are the points that are taken into consideration for disease diagnosis:
- Eden test or soldier posture test is conducted in sitting position where the patient is asked to follow the steps. If during the test there is weakness, numbness or pain in the arms, the test is termed to be positive.
- Deep grooves on the shoulders due to tight straps of brassieres that deeply cuts the tissues of the shoulders. Applying downward pressure with a forefinger in that groove might elevate the pain.
- Tenderness might occur in the acromioclavicular joint that does not allow the free movement of shoulder and neck. It might not be painful but the movement is restricted.
- Paresthesia of skin might involve in arms and fingers. Though here paresthesia does not involve Phalen’s and Tinel’s signs.
- Some people might complain puffy blue hands but not affected by cold.
- The physician also looks for shoulder-hand syndrome where the hand becomes shiny, swollen and hyperaesthetic.
- Other medical examinations can also be done such as normal blood test and x-ray. No changes in the routine blood tests are detected in the patients.
- X ray might show some variation in the image than the normal. Grooves on the shoulder are very difficult to located by x ray.
In various studies it was concluded that radio imaging processes is very important for the diagnosis of this disease and for further investigations and planning.
How to Manage the Costoclavicular Syndrome?
The management of the costoclavicular syndrome includes elimination of the symptoms of the disease.
This includes the following easy methods:
- If the problem is due the brassier straps, strapless brassieres should be worn that can also hold the weight of the mammary gland.
- If strapless brassieres are not available, brassieres with broad straps or padded straps should be worn.
- The patient suffering with this syndrome should avoid lifting shopping bags.
- It is advisable to reduce body weight to eliminate other associated problems.
- Physical therapies should be started with the help of a trainer.
- Pain can be reduced by applying ice pack at the place of tenderness.
- Simple analgesic can also be applied at the local area to reduce pain and tenderness.
- In adverse cases, if needed, reduction of breast size can be done. This is called mammoplasty. It produces better results.
Surgery for treating costoclavicular syndrome should be the last option. Before going for any surgical approach, the conservational approach should be followed which includes physical therapy such as neck and shoulder exercises along with some medication.
Conservation therapy is completed in 3-6 months depending upon the intensity of pain. Stretching exercises are also beneficial. All the physical therapy exercises should be done in the presence of a therapist.
According to a survey, it was reported that in general all patients with costoclavicular compression syndrome, undergoes conservation therapy for a period of 2 months to 12 months.
Massage therapy has also proved beneficial for some patients. Many patients are also benefitted by relaxation sessions and deep breathing exercises.
The patient can also opt for changing the lifestyle to a healthy one with conservative approach. Surgical approaches are also optional these days with minimal invasion techniques.