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Expert Costoclavicular Syndrome Treatment in Delhi

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What is Costoclavicular Syndrome ?

Costoclavicular syndrome is a type of thoracic outlet syndrome (TOS), which occurs when nerves or blood vessels are compressed in the space between the collarbone (clavicle) and the first rib, known as the costoclavicular passage. This compression can lead to a variety of symptoms in the neck, shoulder, arm, and hand.

Causes of Costoclavicular Syndrome

The compression in the costoclavicular passage can arise from several factors:

  • Poor Posture: Rounding and slumping shoulders can narrow the space by depressing the clavicle towards the first rib and pushing the scapula forward.
  • Tight Muscles: Overly tight muscles in the area, such as the subclavius, anterior and middle scalenes, can elevate the first rib or pull the clavicle downwards, reducing the available space.
  • Anatomical Variations: Some individuals are born with an extra rib in the neck (cervical rib) or tight fibrous bands that can compress the neurovascular structures.
  • Trauma: Fractures of the clavicle or first rib, especially those with malunion or excessive callus formation, can narrow the costoclavicular passage.
  • Repetitive Arm Movements: Certain occupations or activities involving repetitive arm movements can contribute to compression.
  • Heavy Loads: Carrying heavy loads on the shoulders (e.g., backpacks, heavy shopping bags) can exert downward pressure on the clavicle.
  • Obesity: Increased weight can sometimes contribute to postural issues that narrow the thoracic outlet.
Symptoms of Costoclavicular Syndrome

Symptoms depend on whether nerves (neurogenic TOS), veins (venous TOS), or arteries (arterial TOS) are compressed. It is common for a combination of these to be affected.

Neurogenic Symptoms (most common):

  • Pain or ache: In the neck, shoulder, arm, and hand. This can be a dull ache, sharp, stabbing, or burning pain.
  • Numbness or tingling (paresthesia): Often in the arm and fingers, sometimes the entire limb.
  • Weakness: In the arm or hand, potentially leading to a weakening grip.
  • Arm fatigue: Especially with activity.
  • Muscle wasting: Occasionally, particularly at the base of the thumb.

Venous Symptoms

  • Swelling: Of the arm or hand.
  • Discoloration: The hand or fingers may appear bluish (cyanosis).
  • Heaviness: In the affected arm.
  • Pain: In the arm or hand.
  • Blood clots: In severe cases, leading to conditions like axillo-subclavian vein thrombosis.

Arterial Symptoms

  • Pain: In the arm or hand.
  • Coldness: Of the fingers, hand, or arm.
  • Pale skin (pallor): In the affected hand or fingers.
  • Weak or absent pulse: In the affected arm.
  • Pulsating lump: Near the collarbone.
  • Slow-healing sores: On the fingers.

Symptoms are often bilateral but can be more pronounced on the dominant side. They tend to be aggravated by work, exercise, and carrying heavy objects, and are often relieved by rest and sleep, being minimal in the morning and worsening as the day progresses.

Physiotherapy for Costoclavicular Syndrome

Physiotherapy is often the first line of treatment for costoclavicular syndrome, especially for the neurogenic type. The primary goals are to decompress the neurovascular structures, improve posture, and restore normal movement and function.

  • Pain Management:-
    • Application of ice or heat to the affected area.
    • Activity modification to avoid positions or movements that exacerbate symptoms.
  • Posture Correction:
    • Exercises and cues to improve shoulder and upper back posture, focusing on retracting and depressing the shoulder blades and promoting an upright spinal alignment.
    • Awareness of daily postural habits.
  • Stretching Exercises: To lengthen tight muscles that may be contributing to compression.
    • Pectoralis stretches: To open up the chest and prevent forward rounding of the shoulders.
    • Scalene muscle stretches: To reduce tension in the neck muscles that can elevate the first rib.
    • Upper cervical spine stretches: To improve neck mobility.
  • Strengthening Exercises: To build strength in muscles that support proper posture and stabilize the shoulder girdle, thereby increasing the space in the thoracic outlet.
    • Shoulder girdle muscles: Such as rhomboids, lower trapezius, and serratus anterior, to pull the shoulder blades back and down.
    • Deep neck flexors: To improve neck stability.
    • Rotator cuff strengthening: To support overall shoulder health.
  • Manual Therapy: “Hands-on” techniques performed by the physiotherapist to:
    • Mobilize the first rib and clavicle to improve joint movement.
    • Release tension in tight muscles through massage or soft tissue mobilization techniques.
    • Improve overall joint mobility in the neck, shoulder, and upper back.
  • Nerve Gliding Exercises (Nerve Flossing): Gentle exercises designed to improve the mobility of the nerves as they pass through the thoracic outlet, reducing irritation.
  • Breathing Mechanics: Addressing any dysfunctional breathing patterns that might involve overuse of accessory breathing muscles (like the scalenes), which can contribute to first rib elevation.

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