Arterial Thoracic Outlet Syndrome
Pathology
Compression of the subclavian artery resulting in any combination of the following:
- Stenosis
- Poststenotic dilation
- Intimal injury
- Aneurysms
- Mural thrombosis
Signs and Symptoms
- Often in young adults with history of vigorous arm activity or can develop spontaneously from arterial emboli
- Pain in the hand, but seldom n the shoulder or neck
- Coolness to touch and pallor/pale discoloration
- Claudication
- Coldness or cold intolerance
- Upper limb ischemia
- Multiple upper limb arterial embolization
- Acute hand ischemia
- Vasomotor phenomena
- Digital gangrene
- Absent or decreased arterial pulse
- Swelling, feeling of stiffness/heaviness, fatigability ,coldness, pain or muscle cramps in the upper limb or hand
- Paresthesia (secondary to ischemia)
- Diminished pulse
- Decreased blood pressure above 20 mmHg in affected arm compared to contralateral upper extremity is a reliable indicator or arterial involvement
(Hooper et. al., 2010; Huang & Zager, 2004; Watson et. al., 2009)