PT3 - Thoracic Outlet Flashcards
1
Q
What are the links from the thorax to wider MSK stystem?
A
- muscles
- fascia
- diaphragms
- vascular
- neurological
2
Q
What are the landmarks of the thoracic outlet?
A
- traps
- pec major + clavicle
- SCM
3
Q
What are the 3 places of compromise for TOS?
A
- scalenes
- subclavian
- pec minor
4
Q
What is TOS?
A
- compression of neuro vascular structures in interscalene triangle
5
Q
What types of TOS are there?
A
- neurogenic
- vascular => arterial or venous => medical emergency
6
Q
What structures are involved in TOS?
A
- cervical ribs
- elongated c7 TPs
- Clarice
- 1st rib
- cervical rib
- scalenes
- fibrous bands
7
Q
How do you diagnose TOS?
A
- challenging due to various symptoms
- double crush syndrome = compression of 2 or more nerves
8
Q
How does neurogenic TOS occur?
A
- trauma to neck/shoulder girdle (usually)
9
Q
How does vascular TOS occur?
A
- repetitive overhead activities
10
Q
Signs, symptoms and population affected by arterial TOS
A
- young adults
- history of arm activity
- pain in hand, but not always shoulder + neck
- pallor
- claudication
- coldness in hand/arm
- parethesia
- diagnose based on Cx
- confirmed through Doppler ultrasound + angiography
11
Q
Signs, symptoms and population affected by venous TOS
A
- often young men
- preceded by excessive activity in arms
- pain
- oedema in arm
- cyanosis
- heavy arm
- parenthesis in fingers + hand
- diagnosis by Cx
- confirmed through venous ultrasound + venous scintillation scans + ventography + plethysmography
12
Q
Signs, symptoms and population affected by True neurogenic TOS
A
- history of neck trauma e.g. car accident, repetitive movement, work stress
- pain
- paresthesia (day + night)
- numbness (day + night)
- weakness in hand + arm (c8 + t1)
- shoulder + neck pain
- occipital HAs
- cold intolerance
- reynaulds
- day symptoms > night
- weakness + sensory deficit
- Cx diagnosis + 2 provocation tests + neurophysiological testing
13
Q
Signs, symptoms and population affected by disputed neurogenic TOS
A
- Cx neck trauma e.g. car accidents, repetitive stress @ work
- pain
- paresthesia (night)
- weakness in hand, arm (c8 + t1), shoulder, neck pain
- occipital HAs
- loss of dexterity
- cold intolerance
- Reynaulds
- hand coldness
- colour changes
- night > day symptoms
- Cx diagnosis + 2 x positive tests
14
Q
Which is more common vascular or neuogenic TOS?
A
- neurogenic
15
Q
What are the tests for TOS?
A
- adson’s - extension + abduction + external rotation of arm + extension + rotation of head towards arm + hold breath => positive on reproduction of symptoms or pulse disappears
- Roos
