3 TOS & Neural Tension Flashcards
What’s Thoracic Outlet Syndrome (TOS)?
Complex of S/S that result from compression of the neurovascular bundle (NB).
What’s the Neurovascular Bundle (NB)?
- brachial plexus
- subclavian vein
- subclavian artery
Where does the Brachial Plexus originate and travel?
- originates C5-T1
- enters between anterior and middle scalene
- under the clavicle
- over the 1st rib
- under the coracoid process posterior to (under) pec minor
What are some possible causes of TOS?
- cervical rib (juts out from C7 – not everyone has one)
- reduced interscalene triangle (ant. scalene syndrome)
- decreased costoclavicular space (costoclavicular syndrome)
- decreased spaced caused by shoulder drop
- callus formation resulting from a clavicular fracture
- also consider nerve root compression
Are ruleouts for frozen shoulder conducted uni or bilaterally?
unilateral (all ruleouts are unilateral except for spine)
What ruleouts are conducted for TOS?
- cervical spine
- shoulder
- thoracic spine (same as lumbar with overpressure)
- elbow
- TMJ
- maybe wrist (flx, ext, uln and rad dev)
How is Adson’s maneuver conducted?
What’s a positive sign?
What’s tested?
What’s tested: NB exit through ant and mid scalenes
How is Travell’s Variation/Halstead Maneuver conducted?
What’s a positive sign?
What’s tested?
What’s tested: NB exit between ant and mid scalene, but this one focuses more on mid scalene
How is Costoclavicular Syndrome Test/Military Stance conducted?
What’s a positive sign?
What’s tested?
How is Wright’s Hyperabduction Test conducted?
What’s a positive sign?
What’s tested?
How is Roos Test/Elevated Arm Stress Test conducted?
What’s a positive sign?
What’s tested?
How is Allen’s Test for the should conducted?
What’s a positive sign?
What’s tested?
What’s the aka for Neural Tension Testing?
aka flossing
What are some indications to perform Neural Tension Testing (aka flossing)?
- presence of adhesive scar tissue around the nerves
- increased pressure on surrounding tissues or nerves (e.g. from increased muscle tone, swelling)
What are some contraindications for Neural Tension Testing (aka flossing)?
- acute inflammatory or unstable neurological signs
- spinal cord injuries
How are Neural Tension Testing (aka flossing) Testing Maneuvers conducted?
How are Neural Tension Testing (aka flossing) Treatment Maneuvers conducted?
When should Neural Tension Testing (aka flossing) maneuvers be stopped?
If px experiences burning or shooting pain, the nerve can be considered irritable and all maneuvers should stop!
What should I do if the nerve has become irritable?
apply cool hydro, light massage and/or fluid techs
How is Upper Limb Neural Tension Test 1 (ULNT1) conducted?
How is Upper Limb Neural Tension 2 (ULNT2) conducted?
What does ULNT1 test?
median nerve
What does ULNT2 test?
- median nerve
- musculocutaneous nerve
- axillary nerve
How is Upper Limb Neural Tension 3 (ULNT3) conducted?
How is Upper Limb Neural Tension 4 (ULNT4) conducted?
How is Lower Limb Neural Tension Test (LLNT) for the Sciatic Nerve conducted? What are the variations for the tibial tract, sural tract, and common peroneal tract?
How is Lower Limb Neural Tension Test (LLNT) for the Femoral Nerve conducted?
What’s the aka for Roos Test?
Elevated Arm Stress Test
What’s the aka for Travell’s Variation?
Halstead Maneuver
What’s the aka for Military Stance Test?
Costoclavicular Syndrome Test
When testing radial/ulnar deviation, should the palm be pronated or supinated?
supinated
What are the TOS tests?
- Adson’s Maneuver
- Halstead Maneuver
- Military Stance
- Wright’s Hyperabduction
- Roos
- Allen’s
- Myotome/Dermatome/DTR
- Muscle Tests
What are the Neural Tension tests for the Brachial Plexus?
- Median Nerve/ULNT1
- Median Nerve/ULNT2
- Radial Nerve/ULNT3
- Ulnar Nerve/ULNT4
