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OPP 3-2 > 3 - Thoracic Outlet Syndrome > Flashcards

3 - Thoracic Outlet Syndrome Flashcards

1
Q

26 yo male with right upper extremity pain and weakness. He is a construction worker and installs drywall and paints. Numbness and tingling of 4th and fifth digits. He feels his arm is heavy and some cervical neck pain. His head and neck carriage is anterior. while his trunk is flexed and side bent to the right. You notice that his right shoulder is more superior. Upon PE, he is neurologically intact and MRI, EMG/NCS is negative. What could be his diagnosis?

A

Thoracic Outlet syndrome (TOS)

or

Postural decompensation

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2
Q

What is Thoracic outlet syndrome?

A

a group of syndromes where biomechanical obstructions compress or osbtruct structures in the thoraccic outlet

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3
Q

What structures are in the thoracic outlet?

A

subclavian artery
axillary artery
subclavian vein
cords of brachial plexus

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4
Q

What are the boundaries of the thoracic outlet? (anterior? posterior? lateral?)

A 
anterior =  manubrium/clavicl
posterior = body of T1
Lateral = ribs 1 and 2 w/ costal cartilage
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5
Q

What are the superficial muscles of the thoracic outlet?

A 
Deltoid M.
Platysmus M.
Scalene M
Sternocleidomastoid M
Trapezius M
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6
Q

The cervico thoracic fascia that tightly confines the neurovascular supply to the arm is also known as?

A

Sibson’s fascia

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7
Q

What are the great deep vessels of the thoracic outlet?

A

Subclavian artery

Subclavian vein

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8
Q

A patient comes in complaining of numbness and tingling to the finger tips. You think it’s Thoracic outlet syndrome. What deep nerves are considered somatic? (more than one may be correct)

a) C5 to T1
b) T1-T4
c) T1-T8
d) T1-T6
e) Brachial Plexus
f) Vagus N.

A

a) C5 to T1

d) Brachial Plexus

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9
Q

What comprises the neurovascular bundle within the thoracic outlet?

A

subclavian artery
subclavian vein
brachial plexus

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10
Q

Does sibson’s fascia also contain lymphatics?

A

Yes sir it does! Sibson wants all the things

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11
Q

Who do I adore most in the world?

A

William Talmadge Gunther III

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12
Q

True or False: The base of the lung is a part of the thoracic outlet.

A

False! The APEX of the lung is apart of the thoracic outlet.

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13
Q

What artiulations help make up the thoracic outlet?

A

Sternal
Acromioclavicular
Sternoclavicular

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14
Q

True or False: ALL thoracic outlet syndromes occur because of a disruption/alteration of the normal anatomy of the thoracic outlet, thus clearly demonstrating the osteopathic principle of structure and function.

A

TRUE! It’s all true!!! bows down

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15
Q

Which structure commonly compresses the thoracic outlet anteriorly?

A

Clavicle/manubrium

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16
Q

Which structure commonly compresses the thoracic outlet dorsal/lateral?

A

Rib 1

17
Q

Which structure commonly compresses the thoracic outlet posteriorly?

A

Cervical Rib

18
Q

A patient comes in telling you that her sister says she has thoracic outlet syndrome because her arm is now showing signs of ischemia, pallor, coolness, cyanosis and decreased peripheral pulse. If the issue is a thoracic outlet syndrome, what is the most common cause of these symptoms?

A

The most common cause of an Artery occlusion related to Thoracic outlet Syndrome (TOS) is PECTORALIS MINOR MUSCULAR COMPRESSION ON THE SUBCLAVIAN/AXILLARY ARTERY.

19
Q

A patient comes in telling you that her brother says she has thoracic outlet syndrome because her arm is now showing swelling. If the issue is a thoracic outlet syndrome, what is the most common cause of these symptoms?

A

The most common cause of a Vein/Lymphatic issue is COMPRESSION of the SUBLAVIAN VEIN against RIB 1 BELOW the CLAVICLE in front

20
Q

A patient comes in telling you that her mom says she has thoracic outlet syndrome because her arm is now showing signs of pain, parasthesias and anesthesias on her left arm. If the issue is a thoracic outlet syndrome, what is the most common cause of these symptoms?

A

The most common cause for a NERVE issue related to TOS is SCALENE COMPRESSION

21
Q

Which is not one of the four neuromuscular syndromes associated with Thoracic Outlet Syndrome?

A) Scalenus Anticus syndrome
B) Cerivcal rib syndrome
c) Costoclavicular syndrome
d) Hyperabduction Syndrome
e) Hypoflexion Syndrome
A

e) Hypoflexion Syndrome

The rest are real!:
A) Scalenus Anticus syndrome
B) Cerivcal rib syndrome
c) Costoclavicular syndrome
d) Hyperabduction Syndrome
22
Q

A positive Adson’s maneuver is indicative of what?

a) compression of the subclavian artery and lower components of the brachial plexus against an aberrant rib
b) entrapment of the subclavian artery and components of the brachial plexus lower chord between the anterior and middle scalene muscles
c) narrowing of the space between the clavicle and the first rib
d) compression of neurovascular structures under the pectoralis minor muscle and under the coracoid process

A

b) entrapment of the subclavian artery and components of the brachial plexus lower chord between the anterior and middle scalene muscles

23
Q

A positive reverse Adson’s maneuver is indicative of what?

a) compression of the subclavian artery and lower components of the brachial plexus against an aberrant rib
b) entrapment of the subclavian artery and components of the brachial plexus lower chord between the anterior and middle scalene muscles
c) narrowing of the space between the clavicle and the first rib
d) compression of neurovascular structures under the pectoralis minor muscle and under the coracoid process

A

a) compression of the subclavian artery and lower components of the brachial plexus against an aberrant rib

24
Q

A positive hyperaduction maneuver is indicative of what?

a) compression of the subclavian artery and lower components of the brachial plexus against an aberrant rib
b) entrapment of the subclavian artery and components of the brachial plexus lower chord between the anterior and middle scalene muscles
c) narrowing of the space between the clavicle and the first rib
d) compression of neurovascular structures under the pectoralis minor muscle and under the coracoid process

A

d) compression of neurovascular structures under the pectoralis minor muscle and under the coracoid process

25
Q

A positive costoclavicular maneuver when causing them go into military posture is indicative of what?

a) compression of the subclavian artery and lower components of the brachial plexus against an aberrant rib
b) entrapment of the subclavian artery and components of the brachial plexus lower chord between the anterior and middle scalene muscles
c) narrowing of the space between the clavicle and the first rib
d) compression of neurovascular structures under the pectoralis minor muscle and under the coracoid process

A

c) narrowing of the space between the clavicle and the first rib, causing pressure on the subclavian artery/vein

26
Q

What is the purpose of electrodiagnostic studies for a thoracic outlet syndrome?

A

To measure the speed of a nerve impulse (Nerve Conduction study) and to record electrical activity directly from the muscle (Electromyogram)

27
Q

What should you always recommend in the treatment plan for a thoracic outlet syndrome?

a) muscle relaxants
b) biofeedback
c) splint
d) exercise- stretch program

A

d) exercise- stretch program

28
Q

26 yo male with right upper extremity pain and weakness. He is a construction worker and installs drywall and paints. Numbness and tingling of 4th and fifth digits. He feels his arm is heavy and some cervical neck pain. he also mentioned that he has been dropping his hammer a lot. What would you recommend for him?

A

SEE A NEUROSURGEON! You sir have loss of motor function (dropping objects). Obviously, I can’t do this in my gorgeous family practice.

29
Q

Who do I love and want to take care of and make happy more than anyone in the world?

A

Karin Hwang

30
Q

What OMT is contraindicated in a pt with thoracic outlet syndrome according to old exams?

A

Cervical muscle energy

OPP 3-2 (8 decks)

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