Clinical Notes from chapter 8 (MA)

Question 1

Thoracic outlet syndrome

Answer 1

Specific affected areas listed below and types of thoracic outlet syndrome listed below:

1. Scalenus anticus syndrome: is the result of compression by a particular broad or spastic anterior scalene muscle that lies anterior to the brachial plexus and subclavian artery.
2. Costoclavicular syndrome: brachial plexus pinched between the clavicle and the first rib
3. Pectoralis minor syndrome: plexus and vessels compressed between the clavicle and the first rib
4. Cervical rib syndrome: caused by an abnormal cervical rib associated with the seventh cervical vertebra; stretching of the brachial plexus and associated vessels secondary to their passing across the extra rib; aggravated by the upper limb being pulled inferiorly during certain activities (for example carrying a bucket of water)

Symptoms of Thoracic outlet syndrome includes
-Possible neurological signs/symptoms: numbness or tingling in the arm and/or hand: pain in the neck, arm, and/or hand; muscle weakness and/ or atrophy

-Possible vascular signs/symptoms: discoloration of the hand; arm and/or hand pain and swelling; weak or no pulse in the affected arm; cold arm and/or hand; numbness or tingling in the hand

Question 2

Neonatal Brachial Plexus Palsy (NBPP)

Answer 2

Neonatal Brachial Plexus Palsy (NBPP): traumatic injury to the brachial plexus that occurs to an infant during childbirth.

• Damage to the upper trunk (C5-C6) (Erbs Palsy): presents as absent shoulder abduction, external rotation, elbow flexion. “waiter tip position”
  • Damage of upper and middle trunks (C5-C7): same as above plus absent/weak elbow extension and wrist extension.
  • Damage to the lower trunk (C8-T1) (Klumpke Palsy): presents as weakness of muscles of the forearm and hand. “Claw hand”
  • Damage to the entire plexus: upper extremity paralysis

Variable sensory loss dependent on the nerve roots involved