HS stands for hyperabduction syndrome. In hyperabduction syndrome, a vascular nerve cord in the arm gets stuck under the bony process of the shoulder blade, causing sensory and blood circulation disorders. Most patients with the syndrome complain of symptoms only when they bring their arms headfirst into maximum abduction. Therapy is usually not required.
What is Hyperabduction Syndrome?
The anatomy understands abduction as a continuation of the arm or leg away from the middle of the body. Hyperabduction syndrome is a rare condition that occurs when the arm is abducted and the limb is moved posteriorly at the same time. The syndrome is characterized by compression of the vascular-nervous cord on the arm and is characterized by symptoms such as sensory disturbances.
In hyperabduction syndrome, the compression of the vascular nerve cord corresponds to a jamming under the coracoid process. It is a bony extension of the shoulder blade. The syndrome is therefore also known as neurovascular abduction syndrome. Many neurovascular syndromes are summarized under the term thoracic outlet syndrome.
In addition to hyperabduction syndrome, this group of diseases also includes, for example, pectoralis minor syndrome, Paget-von-Schroetter syndrome and costoclavicular syndrome. In individual cases, the clinical picture of a neurovascular syndrome can be very similar to other syndromes from this group.
Hyperabduction syndrome is caused by arm movement. The causative movement is an exceptionally strong abduction with simultaneous dorsal movement of the upper extremity, which pushes the nerve-vascular strand in the shoulder area under the bony process of the shoulder.
Since the veins are stuck, the arm no longer receives sufficient blood flow after the compression of the vascular nerve cord and can, for example, become cold or fall asleep. Because nerves are also jammed when the vascular nerve cord is compressed, neurological symptoms can also occur with the syndrome. In this context, common neurological symptoms are abnormal sensations in the fingers or hands.
A feeling of numbness or a feeling of heaviness in the arm can occur as a result of the compression, as well as any coordination disorders of the affected extremity. Disorders of deep sensitivity can also be attributed to the jamming of the vascular nerve cord. The syndrome is often associated with a pre-existing narrowing under the coracoid process.
Symptoms, Ailments & Signs
Patients with hyperabduction syndrome suffer from a complex of symptoms of circulatory and nervous disorders. After the maximum abduction movement or a maximum lifting movement of the arm, there is reduced blood flow in the extremity, which manifests itself primarily in coldness or the arm falling asleep.
The nerve disorders manifest themselves as sensory disorders of the fingers, for example in the form of numbness or at least reduced sensitivity. In some cases, the patients describe the symptoms that occur as similar to Raynaud’s syndrome. In this context, they speak, for example, of radiating pain or sudden pallor of the affected arm.
A pounding or tingling sensation can also be symptomatic. The skin may redden under certain circumstances. Referred pain occurs primarily in those who suffer from an existing narrowing below the scapular process. Typically, symptoms appear primarily during sleep, waking the patient up.
Diagnosis & disease progression
The doctor usually makes the diagnosis of hyperabduction syndrome based on the medical history and further confirms it with a physical examination. As a rule, he will carry out a provocation test or Adson test. For example, he can ask the patient to spread their arms out as far as possible or to raise them as far as possible.
When hyperabduction syndrome is present, the nerve vascular cord will then become trapped under the bony process of the scapula. After about two minutes, you should still be able to feel the radial pulse. However, if there is a narrowing under the shoulder process or under the pectoralis minor muscle, radiating pain occurs after two minutes and the doctor can hardly feel the radial pulse.
The hyperabduction syndrome mainly leads to disturbances in sensitivity and blood circulation in the patient’s arm. In most cases, however, only one side of the body is affected. The arm feels asleep and may tingle or be slightly painful. As a rule, hyperabduction syndrome is not a dangerous syndrome that absolutely needs to be treated. The symptoms usually go away on their own.
Numbness can develop, which can suddenly lead to severe pain. The patient may experience limitations in everyday life and movement. It is not uncommon for the arm to be red or itchy. There are no complications. In most cases, the symptoms occur during sleep, which can lead to sleep disorders in the patient.
Life expectancy is not limited by hyperabduction syndrome. In most cases, hyperabduction syndrome is not treated. Surgical treatment can only be carried out by the doctor if the symptoms restrict everyday life too much. However, the patient’s life expectancy is not reduced by the syndrome.
When should you go to the doctor?
In the case of hyperabduction syndrome, treatment by a doctor is necessary in any case. This disease does not heal itself and in many cases the symptoms worsen. A doctor should be consulted if the person concerned suffers from sensory disturbances or circulatory disorders frequently and without any particular reason. Limbs may fall asleep or tingle. Constant numbness in the extremities can also indicate hyperabduction syndrome and should be examined by a doctor.
The affected areas of the body may also be painful or swollen. Reddened skin is also a sign of the disease. Most complaints occur during sleep and can have a negative effect on the quality of sleep or even wake up the person concerned. Hyperabduction syndrome can usually be diagnosed by a general practitioner. During treatment, however, interventions by various specialists are necessary in order to permanently resolve the symptoms. The life expectancy of those affected is usually not reduced by the disease.
Treatment & Therapy
Hyperabduction syndrome only requires further therapy in the rarest of cases. The disturbances that occur are unpleasant, but not particularly dangerous. Apart from that, they usually disappear into thin air as soon as the affected person repositions the arm. If the patient suffers from the syndrome, the doctor may recommend a conservative therapy method, in which he attaches his arm to the leg of the respective side before going to bed.
In this fixed position, there are no more complaints, since the arm can no longer be brought to maximum abduction head-to-head. A conventional sling can be used for fixation. If there is severe tightness under the pectoralis minor muscle and the scapula, an invasive procedure can be used to resolve the causal tightness. However, such an intervention is only indicated if the blockage persists and the vessels and nerves are at risk of permanent damage.
In the case of patients whose job regularly requires maximum abduction of the arms at the head, surgical resolution of the existing narrowness can make sense, for example. The operation takes the form of a deinsertion of the pectoralis minor muscle. As a rule, the hyperabduction syndrome never recurs in patients treated in this way.
Outlook & Forecast
The prognosis of hyperabduction syndrome is very favorable. Normally, there is no need for action, as spontaneous healing occurs. The complaints resolve completely on their own within a short period of time. Consequential damage or impairments are not to be expected in the long term. The inconveniences encountered are temporary and do not cause permanent damage. Sufficient rest and rest should take place for the occurrence of freedom from symptoms. This shortens the healing time. In addition, the self-healing powers are better activated.
Over the course of life, hyperabduction syndrome can occur again. In these cases, the prognosis is also favorable. The return of the symptoms does not lead to any changes in the healing process. If the affected person continues to exert undiminished strain on his body despite the existing symptoms, a delay in the healing process can be expected. This interrupts the time needed for regeneration and triggers the delays. In order to avoid consequential damage or inflammation in the organism, the affected person should adhere to the guidelines of rest or immobilisation of the arm. Otherwise complications are to be expected.
If medication is taken because of the existing pain, there can be risks and side effects. The drugs have a negative impact on certain organs and lead to addiction in many people.
Hyperabduction syndrome can be avoided by not bringing the arms headfirst into maximum abduction, especially when sleeping. This can be achieved, for example, with a sling that connects the arms to the legs and thus prevents the abduction movement over the head.
In the case of hyperabduction syndrome, the person affected has no special measures or options for aftercare. The patient is primarily dependent on a quick and early diagnosis, so that there is no further deterioration of the symptoms or further complications. It cannot heal on its own, so the focus is on early detection and treatment of this disease.
In most cases of hyperabduction syndrome, fixation can be used to relieve discomfort. This should be maintained until the symptoms have completely disappeared. However, hyperabduction syndrome does not always require treatment. However, surgery may also be necessary to relieve symptoms.
After such a procedure, the person concerned should definitely rest and take care of his body. Stressful or physical activities should be avoided to speed healing. The help and support of your own family and friends can also be useful. Contact with other people affected by this disease is often worthwhile, as this leads to an exchange of information.
You can do that yourself
In many cases, hyperabduction syndrome can be prevented directly if the person concerned does not position their arms above their head while sleeping. In severe cases, a sling can also be used to connect the legs to the arms to prevent movement.
In many cases, however, no treatment of the syndrome is necessary. This also applies if the patient suffers from limitations in his everyday life. While these can be uncomfortable, they do not always require treatment. If the person concerned is dependent on the abduction movement in his everyday life or because of his job, a surgical intervention may be necessary. Patients do not have the option to help themselves. As a rule, all activities or movements that lead to symptoms of hyperabduction syndrome should be avoided. 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 discomfort goes away on its own as soon as the arms are brought into a normal position. If the symptoms occur regularly, it is highly advisable to see a doctor.