NEUROLOGICAL THORACIC OUTLET SYNDROME SKIN

Laboratory TestsĪny patient presenting with jaundice should have the following bloods taken: Hence, whilst a complete list of investigations is given below, these should be tailored to the clinical features of the patient. In many cases, the likely underlying cause can be elicited from the history, with the investigations simply confirming suspicions. Table 1 – Potential Causes for Jaundice, divided into pre-hepatic, hepatocellular, and post-hepatic Extra-mural causes, such as pancreatic cancer or abdominal masses (e.g.Mural causes, such as cholangiocarcinoma, strictures, or drug-induced cholestasis.Intra-luminal causes, such as gallstones.Primary biliary cirrhosis or primary sclerosing cholangitis.

The bilirubin that is not excreted will have been conjugated by the liver, hence the result is a conjugated hyperbilirubinaemia. Post-hepatic jaundice refers to obstruction of biliary drainage. This leads to both unconjugated and conjugated bilirubin in the blood, termed a ‘mixed picture’. The liver loses the ability to conjugate bilirubin, but in cases where it also may become cirrhotic, it compresses the intra-hepatic portions of the biliary tree to cause a degree of obstruction. In hepatocellular (or intrahepatic) jaundice, there is dysfunction of the hepatic cells. This causes an unconjugated hyperbilirubinaemia.Īny bilirubin that manages to become conjugated will be excreted normally, yet it is the unconjugated bilirubin that remains in the blood stream to cause the jaundice. In pre-hepatic jaundice, there is excessive red cell breakdown which overwhelms the liver’s ability to conjugate bilirubin. There are three main types of jaundice: pre-hepatic, hepatocellular, and post-hepatic.

If these treatments do not help, surgery may be an option.By Johndheathcote, via Wikimedia Commonsįigure 2 – Bilirubin is produced as a byproduct of haem metabolism Types of Jaundice If you develop blood clots you may be prescribed medicines to break them up (thrombolytics), and anticoagulants to prevent further clots developing. To relieve any pain and swelling, your GP may prescribe a non-steroidal anti-inflammatory drug (NSAID), such as naproxen or diclofenac. Seeing an occupational therapist may also be useful for advice about techniques to protect your back and neck while at work. Massage may also help release any tight or shortened neck tissues. Shoulder exercises can help stretch and strengthen the neck area and correct poor posture. If you have thoracic outlet syndrome, your GP may refer you for physiotherapy. These symptoms vary widely from person to person. swelling in the affected arm (although this is rare).

NEUROLOGICAL THORACIC OUTLET SYNDROME SKIN

a blood clot that forms in the subclavian artery – which can affect the blood supply to the fingers, causing small red or black patches on the skin.

Raynaud's phenomenon – a condition that affects the blood supply to the fingers and toes, turning them white.

temporary inability to carry out fine hand movements – such as doing up buttons.

temporary loss of feeling, weakness or tingling in the affected arm and fingers.

pain in your neck and shoulder, which spreads into your arm – this may be constant or come and go.

Symptoms of thoracic outlet syndrome include: Not all people with a cervical rib develop thoracic outlet syndrome, and the syndrome can also be caused by other conditions. Thoracic outlet syndrome usually starts between 20 and 50 years of age, and is more likely to affect men than women.Īround 1 in 10 people with a cervical rib will get thoracic outlet syndrome. This is known as thoracic outlet syndrome. It's not usually a problem, but if it presses on nearby nerves and blood vessels, it can cause neck pain, numbness in the arm and other symptoms. It may be a fully formed bony rib or just a thin strand of tissue fibres.Ī cervical rib is an abnormality that's present from birth. You can have a cervical rib on the right, left, or on both sides. A cervical rib is an extra rib that forms above the first rib, growing from the base of the neck just above the collarbone.

Neurological thoracic outlet syndrome