Costoclavicular Syndrome
Original Editor - Venus Pagare
Top Contributors - Ilona Malkauskaite, Venus Pagare, Esraa Mohamed Abdullzaher, WikiSysop, Claire Knott, Evan Thomas, Kim Jackson and Aminat Abolade
Introduction[edit | edit source]
<ref> tag; name cannot be a simple integer. Use a descriptive title The costo-clavicular passage is formed by the clavicle antero-laterally, the first rib medially, and the scapula posteriorly.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The brachial nerve plexus, subclavian artery and subclavian vein run within the costoclavicular space between the first rib and the clavicle.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleThe neurovascular bundle is vulnerable to compression in this space.Cite error: Invalid
<ref> tag; name cannot be a simple integer. Use a descriptive titleMechanism[edit | edit source]
The costoclavicular syndrome was first described in soldiers with loaded knapsacks, who developed pain, numbness, and fatigueability of the arms as they stood at attention.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The mechanisms of compression involved downward movement of the clavicle against the first rib, with a resultant tendency to shearing of the neurovascular bundle.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
This can occur in three ways:
- The clavicle depresses toward/against the first rib. This can be observed in the common postural condition of rounding and slumping of the shoulders.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title This narrows the costoclavicular passage by pushing the scapula forwards.Cite error: Invalid<ref>tag; name cannot be a simple integer. Use a descriptive title - A tight subclavius can also cause this to occur.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title A similar mechanism operates in usually obese, middle aged or elderly women. Tight, narrow brassiere straps supporting heavy breasts cut into the soft tissues around the shoulders and exert direct downward pressure on the clavicles, usually around the junction of the mid and lateral thirds. A scissoring action of the clavicle against the first rib narrows the costoclavicular passage and shears the neurovascular bundle.Cite error: Invalid<ref>tag; name cannot be a simple integer. Use a descriptive title - The first rib elevates toward/against the clavicle. This often occurs in clients who have laboured breathing. Tight anterior and middle scalenes and subclavius can also cause this to occur.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - The clavicle depresses and the first rib elevates.Cite error: Invalid
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Presenting Complaints[edit | edit source]
Pain or ache sometimes accompanied by stiffness in the neck and shoulders, pain, paraesthesiae, and fatigueability of the upper limbs are the main presenting complaints. Symptoms are usually bi-lateral, though more pronounced on the dominant side. They are aggravated by work and exercise, particularly carrying heavy shopping bags. Symptoms are relieved by rest and sleep, are minimal or absent in the morning, and become pronounced as the day progresses. Patients occasionally complain of puffy blue hands.
