From the Guidelines
Costoclavicular Syndrome typically presents with venous symptoms, frequently denoted as venous TOS (vTOS), with varying degrees of additional symptoms due to arterial or brachial plexus compression. The syndrome often manifests with pain, numbness, and tingling in the neck, shoulder, arm, and hand due to compression of the neurovascular bundle between the clavicle and first rib 1. Patients may report symptoms that worsen with specific arm positions, particularly when the shoulders are pulled back and down. Common presentations include:
- Pain radiating down the arm following the distribution of affected nerves
- Weakness or heaviness in the arm
- Swelling of the affected limb
- Discoloration (pallor or cyanosis)
- Decreased pulse in the affected extremity These symptoms can be exacerbated by activities that require arm elevation or when carrying heavy objects, and may also be triggered by certain postures such as military brace position or when wearing heavy backpacks or shoulder straps 1. The condition may be more prevalent in individuals with anatomical variations like cervical ribs, those with poor posture, or athletes who perform repetitive overhead movements, which can lead to repetitive stress and narrowing of the costoclavicular space 1. Diagnosis typically involves physical examination with provocative maneuvers, and understanding the various anatomic spaces and causes of narrowing is important in choosing and interpreting radiological imaging to help diagnose Costoclavicular Syndrome 1.
From the Research
Typical Presentations of Costoclavicular Syndrome
The Costoclavicular Syndrome presents with a variety of symptoms, including:
- Neck, shoulder, and arm pain 2
- Brachial plexopathy 3
- Neurovascular compression 4
- Stenoses at the costoclavicular junction (CCJ) 5
- Swelling of the arm and/or head 5
- Dysfunction of arteriovenous (AV) fistulae 5
Causes and Associations
The syndrome can be caused by:
- Abnormal compressions of nerve, arterial, and venous structures at the base of the neck or thoracic outlet 4
- Supernumerary cervical rib, abnormal ligaments, and musculus scalenus anterior hypertrophy 4
- Positional alterations interfering with the normal inter-reactions between the first rib and structures overlying it 4
- Exuberant callus associated with a displaced midclavicular fracture 3
- Tight, narrow brassiere straps in obese, heavy-breasted, middle-aged or elderly women 2
Clinical Features and Diagnosis
The clinical features and electrodiagnostic findings are crucial in suggesting the diagnosis 3, which can be confirmed by radiographic studies and surgical exploration 3. The diagnosis of Costoclavicular Syndrome can be complex, and there are no specific tests or pathognomonic symptoms to identify the disease with certainty 6.
Treatment and Management
Treatment may involve surgical management, including decompression of the costoclavicular groove 4, claviculectomy 5, first rib resection 5, and endovascular intervention as needed 5. Non-surgical measures, such as the use of a shoulder pad, can also be effective in simple cases 2.