In hyperabduction syndrome, a vascular nerve cord of the arm becomes jammed under the bony process of the scapula, causing disturbances in sensation and blood flow. Most patients of the syndrome complain of symptoms exclusively when they bring the arms headward to maximum abduction. Therapy is usually not required.
What is hyperabduction syndrome?
Abduction in anatomy is a continuation of the arm or leg away from the center of the body. Hyperabduction syndrome is a rare condition that occurs when the arm is abducted and the limb is simultaneously moved dorsally. The syndrome is characterized by compression of the vascular nerve cord on the arm and is accompanied by symptoms such as sensory disturbances. In hyperabduction syndrome, compression of the vascular nerve cord corresponds to entrapment under the coracoid process. This is a bony process of the scapula. The syndrome is therefore also known as neurovascular abduction syndrome. Many neurovascular syndromes are grouped under the term thoracic-outlet syndrome. In addition to hyperabduction syndrome, this group of diseases includes, for example, pectoralis-minor syndrome, Paget-von-Schroetter syndrome, and costoclavicular syndrome. In individual cases, the clinical presentation of a neurovascular syndrome may bear close resemblance to other syndromes in this group.
Causes
The cause of hyperabduction syndrome is motion of the arm. Thus, the causative movement involves abnormally strong abduction with concomitant dorsal movement of the upper extremity, which pushes the nerve-vascular cord in the shoulder region under the bony process of the shoulder. Because veins are jammed, the arm does not receive adequate blood flow after compression of the vascular nerve cord and may, for example, become cold or fall asleep as a result. In addition, because nerves are also pinched when the vascular nerve cord is compressed, neurological symptoms may develop with the syndrome. In this context, common neurological symptoms are insensitivity of the fingers or hands. A feeling of numbness or heaviness of the arm can develop as a result of the compression, as can any coordination disorders of the affected extremity. Disturbances of deep sensibility are also due to the jamming of the vascular nerve cord. Often, the syndrome is associated with preexisting tightness beneath the coracoid process.
Symptoms, complaints, and signs
Patients of hyperabduction syndrome suffer from a complex of symptoms of circulatory and nerve dysfunction. After maximal abduction movement or maximal lifting movement of the arm, there is a decrease in blood flow to the extremity, manifested mainly by coldness or a falling asleep of the arm. The nerve disorders manifest themselves as sensory disturbances of the fingers, for example, in the form of numbness or at least decreased sensitivity. In some cases, patients also describe the symptoms that occur as similar to a Raynaud’s syndrome. In this context, they speak, for example, of radiating pain or sudden pallor of the affected arm. Symptomatic may also be tapping or tingling sensations. The skin may redden under certain circumstances. Radiating pain is most common in those suffering from existing tightness below the scapular process. Typically, symptoms occur primarily during sleep and awaken the patient.
Diagnosis and course of the disease
The physician usually makes the diagnosis of hyperabduction syndrome based on the patient’s history and further corroborates it with a physical examination. He will usually perform a provocation test or Adson test. For example, he may ask the patient to maximally abduct or maximally raise his arms headward. If hyperabduction syndrome is present, this will cause the vascular nerve cord to pinch under the bony process of the scapula. After about two minutes, the radial pulse should actually still be easily felt. However, if there is a constriction under the shoulder process or below the pectoralis minor muscle, radiating pain will occur after two minutes and the physician will hardly be able to feel the radial pulse.
Complications
Hyperabduction syndrome predominantly causes disturbances in sensitivity and blood flow to the patient’s arm. In most cases, however, only one side of the body is affected. The arm feels asleep and may tingle or ache a bit. As a rule, hyperabduction syndrome is not a dangerous syndrome that necessarily requires treatment. The symptoms usually disappear on their own. However, numbness may develop, which may suddenly turn into severe pain. The patient may experience restrictions in everyday life and movement. It is not uncommon for the arm to be red or itchy. Complications do not occur. In most cases, the symptoms occur during sleep, so that the patient may experience sleep disturbances. Life expectancy is not limited by hyperabduction syndrome. Treatment of hyperabduction syndrome does not take place in most cases. Only if the symptoms restrict everyday life too much, a surgical treatment can be performed by the physician. However, the patient’s life expectancy is not limited by the syndrome.
When should one go to the doctor?
In hyperabduction syndrome, treatment with a doctor is necessary in any case. There is no self-healing in this disease and in many cases the symptoms worsen. A doctor should be consulted if the affected person suffers from sensory disturbances or disturbances of blood circulation frequently and without any particular reason. Limbs may fall asleep or tingle. Similarly, constant numbness in the extremities may indicate hyperabduction syndrome and should be evaluated by a physician. The affected areas of the body may also be painful or swollen. Reddened skin is also indicative of the condition. Most of the symptoms occur during sleep and can have a negative effect on the quality of sleep or even wake up the affected person. Usually, hyperabduction syndrome can be diagnosed by a general practitioner. However, treatment requires interventions by various specialists to permanently resolve the symptoms. The life expectancy of the affected person is usually not reduced by the disease.
Treatment and therapy
Hyperabduction syndrome rarely requires further therapy. The disorders that occur are unpleasant but not further dangerous. Apart from that, they usually disappear into thin air as soon as the affected person positions the arm differently. If the patient suffers from the syndrome, the doctor can recommend him a conservative therapy method, in which he fixes his arm to the leg of the respective side before going to bed. In the position fixed in this way, there is no more discomfort, because the arm cannot be brought to maximum abduction headward. A conventional sling can be used for fixation. If there is severe tightness under the pectoralis minor muscle and the scapula, an invasive procedure may be used to causally release the tightness. However, such an intervention is indicated only if the tightness persists and the vessels and nerves are in danger of sustaining permanent damage. For example, in patients whose occupation regularly requires maximum abduction of the arms from the head, surgical release of the existing tightness may make sense. The operation takes the form of a deinsertion of the pectoralis minor muscle. Usually, hyperabduction syndrome never recurs in patients treated in this way.
Outlook and prognosis
The prognosis of hyperabduction syndrome is very favorable. Normally, there is no need for action, as spontaneous healing occurs. The symptoms completely resolve on their own within a short time. Consequential damage or impairment is not to be expected in the long term. The discomforts that occur are of a temporary nature and do not cause any permanent damage. For the onset of freedom from symptoms, sufficient rest and sparing should take place. This will shorten the healing time. In addition, the self-healing powers are thus better activated. In the course of life, hyperabduction syndrome may recur. In these cases, the prognosis is also favorable. The recurrence of the symptoms does not lead to any changes in the healing process.If the affected person continues to put undiminished strain on his body despite the symptoms present, a delay in the healing process is to be expected. This interrupts the necessary time for regeneration and triggers the delays. To avoid consequential damage or inflammation of the organism, the affected person should adhere to the guidelines of rest or immobilization of the arm. Otherwise, complications are to be expected. If medications are taken due to the existing pain, there may be risks and side effects. The drugs have a negative effect on certain organs and lead to addiction in many people.
Prevention
Hyperabduction syndrome can be prevented by not bringing the arms to maximum abduction headward, especially when sleeping. This can be accomplished, for example, by using a sling to connect the arms to the legs to prevent abduction movement over the head.
Follow-up
In hyperabduction syndrome, no special measures or options for follow-up care are available to the affected person. The patient is primarily dependent on a quick and early diagnosis to prevent further worsening of symptoms or further complications. There can be no self-healing, so the focus is on early detection and treatment of this disease. In most cases, fixation can be performed for hyperabduction syndrome to relieve discomfort. This should be maintained until the discomfort is completely gone. However, treatment is not always necessary for hyperabduction syndrome. However, surgical intervention may be necessary to relieve the symptoms. After such a procedure, the affected person should definitely rest and take care of his or her body. Stressful or physical activities should be avoided to speed up the healing process. The help and support of one’s own family and friends can also be useful. Contact with other sufferers of this disease is also often worthwhile, as it leads to an exchange of information.
What you can do yourself
In many cases, hyperabduction syndrome can be prevented directly by the sufferer not positioning their arms above their head when sleeping. In severe cases, a sling that connects the legs to the arms can also be used for this purpose to prevent movement. In many cases, however, no treatment for the syndrome is necessary. This is true even if the patient suffers from restrictions in his or her daily life. While these can be uncomfortable, they do not always require treatment. If the affected person is dependent on the abduction movement in his daily life or through his job, surgical intervention may be necessary. Self-help options are not available to the patient in this case. As a rule, all activities or movements that lead to symptoms of hyperabduction syndrome should be refrained from. If the patient suffers from reduced sensitivity due to the syndrome, this can possibly be alleviated by massage or heat applications. In many cases, the symptoms also go away on their own as soon as the arms are brought into a normal position. If symptoms occur on a regular basis, seeking medical attention is highly advisable.
