3 - Thoracic Outlet Syndrome Flashcards
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?
Thoracic Outlet syndrome (TOS)
or
Postural decompensation
What is Thoracic outlet syndrome?
a group of syndromes where biomechanical obstructions compress or osbtruct structures in the thoraccic outlet
What structures are in the thoracic outlet?
subclavian artery
axillary artery
subclavian vein
cords of brachial plexus
What are the boundaries of the thoracic outlet? (anterior? posterior? lateral?)
anterior = manubrium/clavicl posterior = body of T1 Lateral = ribs 1 and 2 w/ costal cartilage
What are the superficial muscles of the thoracic outlet?
Deltoid M. Platysmus M. Scalene M Sternocleidomastoid M Trapezius M
The cervico thoracic fascia that tightly confines the neurovascular supply to the arm is also known as?
Sibson’s fascia
What are the great deep vessels of the thoracic outlet?
Subclavian artery
Subclavian vein
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) C5 to T1
d) Brachial Plexus
What comprises the neurovascular bundle within the thoracic outlet?
subclavian artery
subclavian vein
brachial plexus
Does sibson’s fascia also contain lymphatics?
Yes sir it does! Sibson wants all the things
Who do I adore most in the world?
William Talmadge Gunther III
True or False: The base of the lung is a part of the thoracic outlet.
False! The APEX of the lung is apart of the thoracic outlet.
What artiulations help make up the thoracic outlet?
Sternal
Acromioclavicular
Sternoclavicular
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.
TRUE! It’s all true!!! bows down
Which structure commonly compresses the thoracic outlet anteriorly?
Clavicle/manubrium
Which structure commonly compresses the thoracic outlet dorsal/lateral?
Rib 1
Which structure commonly compresses the thoracic outlet posteriorly?
Cervical Rib
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?
The most common cause of an Artery occlusion related to Thoracic outlet Syndrome (TOS) is PECTORALIS MINOR MUSCULAR COMPRESSION ON THE SUBCLAVIAN/AXILLARY ARTERY.
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?
The most common cause of a Vein/Lymphatic issue is COMPRESSION of the SUBLAVIAN VEIN against RIB 1 BELOW the CLAVICLE in front
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?
The most common cause for a NERVE issue related to TOS is SCALENE COMPRESSION
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
e) Hypoflexion Syndrome
The rest are real!: A) Scalenus Anticus syndrome B) Cerivcal rib syndrome c) Costoclavicular syndrome d) Hyperabduction Syndrome
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
b) entrapment of the subclavian artery and components of the brachial plexus lower chord between the anterior and middle scalene muscles
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) compression of the subclavian artery and lower components of the brachial plexus against an aberrant rib
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
d) compression of neurovascular structures under the pectoralis minor muscle and under the coracoid process
