Nerve Entrapment/ Injury of Upper Quadrant Flashcards
Name the sensory nerve that branches off C2 to feed the posterior scalp and potentially gets caught in the upper trapezius?
Greater Occipital Nerve
Thoracic Outlet Syndrome is a manifestation of symptoms resulting from what?
Compression of neuromuscular bundle of subclavian artery, vein, and brachial plexus
What are the most common structures that would stress the neurovasuclar bundle and how do they effect it?
Scalenes: Cause entrapment by hypertrophy or spasm
Ribs: If 1st rib is at C7 then nerves have less room
Clavicle: old fx, UT tissues come under rib and clavicle/ pec minor
What 4 other causes may stress the neuromuscular bundle?
- Coaracoid Process: problem for overhead athletes, can impinge those nerves
- Pec Minor: hypertrophy, same as above
- Subclavius: hypertrophy
- Costocoracoid Lig: vascularity runs under and may pinch
Name the 4 types of TOS and the percentages at which they occur.
- Neurologic 94-97%
- Venous: not listed
- Arterial 1-2.5%
- Combined: not listed
Which of the neurological TOS is more common? Where would they have plain?
Lower Plexus: causes compression of C8-T1 nerves.
Pain in upper back, into axilla along ulnar nerve to ring and small finger
The upper plexus TOS is less common and involves C5-C7. Where would this patient experience pain?
Pain in ear, anterior c-spine, clavicle, chest, and outer aspect of arm (along radial nerve)
Give some of the issues found with venous TOS.
Edema, cyanosis of UE
Distended superficial veins in shoulder and chest
Axillary Vein Thrombosis- maybe
Fingers feel like sausages- In subjective hx
Which is the least common TOS? What are some of the symptoms?
Arterial: arms get cold and pale, may have Raynauds, can be in pitchers from overuse. Rarest and worst!!
T/F: Combined TOS can include pinching of the nerve, vein, and artery simultaneously.
True
Patients with TOS usually fall into what demographics?
Middle aged (~45) and women
Patient will have UE pain, anesthesia, and weakness. Where would each of these be felt on the patient?
Pain: arm extending to fingers, claudicant slowly increases with activity and is relieved by rest.
Anesthesia/paraesthesia: Ring, middle, and small fingers. Pt may shake hand to relieve symptoms
Weakness in Thenar muscles
If a patient feels pain the hand first what could this mean?
It could be the vascular form of TOS
What special tests are used to make the diagnosis of TOS?
Adsons Wright Costoclavicular Roos ULTT
What is the conservative treatment of TOS?
- Stretching: Scalenes and Pec minor (stay away from tx which can cause scalene spasm)
- Strengthen muscles to promote posture
- Postural re-education is KEY. Cervical ribs and anomalous fascial bands present for a while.
- MFR: alters resting tone than change non-contractile structures
- 1st rib mobs
- Rest
- Modalities
What is the surgical treatment of TOS?
- Resection of fibrous bands
- Scalenotomy
- Removal of cervical rib (only 10% of population)
* *Sx not generally regarded as having a high success rate**
What is a stinger?
Brachial plexopathy; brachial plexus traction injury that is common and is unique to football.
What is the mechanism of injury for a stinger? How would you identify and treat this?
Mechanism: Shoulder depression or direct compression on the brachial plexus from poorly fitting pads
S/S: Acute shooting or electrical pain down arm following tackle, weakness, usually C5-C6 that may last from a few seconds to many months
Treatment: Rest and ice, strengthening, check fitting of shoulder pad (use spider), return to football when MMT 5/5, strength deficits may persist for months
There are 4 concepts in evaluating a nerve injury that you should keep in mind. What are they?
- Mechanical interface
- Nerves are elastic
- Tension on a nerve increases intramural compression
- Tension in nervous system by movement is not uniform
When evaluating pain from compromise neurodynamics what should you keep in mind?
- Pain source
- Area od symptoms
- Types of symptoms
What painful sources should you consider with compromised neurodynamics?
- Connective Tissue- dura mater
2. Neural Tissue
Give the terminology for areas of symptoms.
Jumping: pain in one part, now in another
Lines: pathways of pulling, tightness
Clumps: Areas of pain usually around joints and tension points (ex: head of fibula or lat. epicondyle)
Linking up of symptoms (ex. double crush)
Types of symptoms can be _______ and _______. Symptoms include:
Multiple and bizarre; tiredness, aching, burning, heaviness, and vague types of pain
What are the 4 treatment principles for a nerve injury?
- Treat any related jt hypomobility or hypermobility that may be present first.
- Very careful with irritable patients
- Start gently with stretching techniques that you used to elevate.
- Joint should not be stressed during the treatment.
