L19 Thoracic Outlet Syndrome

Question 1

thoracic outlet syndrome

Answer 1

uncommon cause of UE neuropathy
neuro or vasculogenic compromise from thoracic outlet
diagnosis of exclusion

Question 2

structures of the thoracic outlet

Answer 2

clavicle
first rib
subclavius
costoclavicular ligament
anterior scalene

Question 3

neuralvascular structures being compressed

Answer 3

brachial plexus
subclavian vein and artery

Question 4

types of thoracic outlet

Answer 4

neurogenic form 95%
vascular form 4% venous, 1% arterial

Question 5

causes of compression in TO

Answer 5

cervical rib
elongated vertebral TP of C7
scalene muscle insertion anomaly
first rib malunion
repetitive shoulder movement
extreme arm positions
abnormal pec minor muscle
weight lifting, rowing, swimming

Question 6

three areas of compression

Answer 6

scalene triangle
costoclavicular triangle
pec minor space

Question 7

epidemiology of TO

Answer 7

congenital: cervical rib, prolonged TP, scalene insertion anomaly
acquired: posture, dropped shoulder, heavy breasts, hyperextensioin, WAD, repetitive stress
muscular: hypertrophy scalene, screased trap tones, levator, rhomboids, shortened scalenes, traps, levator, pec

Question 8

neurogenic TOS

Answer 8

compression in scalene triangle
normal nerve conduction
hx of neck trauma
pain and paresthesia
aggravated by OH shoulder movement

Question 9

venous TOS

Answer 9

compression of subclavian vein in costoclavicular space
overhead athletes
s/s of heaviness and cyanosis

Question 10

arterial TOS

Answer 10

compression of subclavian artery from bones
have 5 Ps of ischemia
angiography
hand ischemia, ulcers, pain
exertional arm pain