Submitted by Dr T on September 18, 2010 – 10:50am
Interesting question, one of these situations where the possibilities range from nothing to serious.
Your symptoms are not that specific, so let me address these different scenarios that would look to address your concerns:
1. A Subclavian Artery stenosis (blockage).
2. A Subclavian Vein Thrombosis.
3. A Thoracic Outlet Syndrome.
4. A Brachial Plexus injury.
I’d be looking to exclude or confirm these particular problems if you came to my office. Each has its own findings and treatments, so let’s start with no.1:
1. Subclavian Artery Stenosis
A blockage in the subclavian artery at your age due to atherosclerosis is possible but unlikely and the condition you mentioned. Likewise, direct injuries are uncommon, because the arteries are well protected by surrounding structures of the chest.
- Symptoms: The symptoms of Subclavian Artery Stenosis are those of insufficient blood supply anywhere in your body: Your arm “tires easily” with exercise, and since there would be less blood circulating in comparison to the other arm, the affected site would be colder.
- Findings: Problems with the arterial circulation would be associated with findings such as an absent pulse in your wrist, or “bruits” or “thrills” when you listen with a stethoscope or put your finger over the area beneath your collar bone.
- Treatment: If severe, it may require surgery , either replacement of the site with a graft or placement of a “Stent” across the area of stenosis.
2. Subclavian Vein Thrombosis
Upper extremity deep venous thrombosis is an uncommon vascular problem, occurring primarily in young, healthy, active people. It may be caused by Overexertion of the neck and upper-arm muscles and is called:
Effort subclavian vein thrombosis ( Paget-Schrotter syndrome) a blood clot in the subclavian vein. The blood clot causes blood to back up in the veins of the arm, causing it to swell and ache.
- Pain, swelling or congestion in the affected arm
- Affected arm may turn blue
- Magnetic Resonance Venous (MRV) imaging
- Anticoagulattion medications: the use of blood thinners such as heparin and Coumadin and Aspirin.
- Thrombolysis: Dissolve the clot directly.
- Surgery: If possible, correct the formation of the blood clot.
3. Thoracic Outlet Syndrome
It occurs when the artery, vein or brachial plexus is compressed between the first rib and collarbone.
- Presence of an extra rib above the first rib that compresses the subclavian vein
- Previous fracture of the collarbone or first rib
- An abnormal ligament that compresses the subclavian vein
- Repetitive movement of the arm and shoulder with the arm extended over the head (often occurs with swimmers, tennis players, baseball pitchers, basketball players and people in certain jobs (Paget-Schrotter syndrome, see above)
- The same as above
- All the measure mentioned before may need to be taken if there is evidence of a stenosis in the artery or thrombosis in the vein
- If the problems is caused by compression, sometimes a portion of the rib involved may be necessary
4. Brachial Plexus injury
The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm and hand. Brachial plexus injuries are caused by damage to those nerves. Symptoms may include a limp or paralyzed arm; lack of muscle control and/or a lack of feeling or sensation. Brachial plexus injuries can occur as a result of shoulder trauma, tumors, or inflammation.
Diagnosis is complicated and may require a number of tests:
- Thorough medical history and physical examination
- Magnetic resonance imaging (MRI)
- Electromyogram (EMG or electromyography)
- Nerve conduction study
- Some brachial plexus injuries may heal without treatment.
- Other injuries require physical therapy or surgery.
Hope this was helpful,