SHOULDER TOS Flashcards
1
Q
SHOULDER TOS classic presentation
A
violinist with rounded shoulders and ant. head carriage
2
Q
similar DDX’s
A
- vascular vs neurogenic
- cerv. disc/ stenosis/ DJD/ sprain and strain
- rib subluxation
- thrombosis
- carpal tunnel syndrome
3
Q
supporting factors
A
- repetitive overhead activities
- tingling especially in ulnar distribution of hand
- tight SCMs, scalenes, pecs
- clavicle deformities
- ant. head carriage, rounded shoulders and hyperkyphosis
- vascular TOS = raynauds phenomenon (cold or pale limbs)
- neurogenic TOS = atrophy and arm weakness
4
Q
refuting factors
A
- simultaneous bilateral onset
- UMN signs in upper and lower limbs
- only one dermatome affect (means disc)
5
Q
relevant orthos
A
- FIRST TEST ALLENS (to rule out vascular)
- adsons and reverse adsons (scalene anticus and cerv. rib)
- costoclavicular and edens (costoclavicular)
- EAST and intermittent (scalene anticus)
- wrights (pec minor)
6
Q
physical findings
A
- true TOS = arm symptoms and dec. amplitude in radial pulse
7
Q
neuro test
A
- dermatome = C8/T1 distribution or ulnar nerve reduced
- myotomes = weakness in hand, finger flex. and finger add/abduction
8
Q
referrals
A
- x-ray for cerv. ribs
- massage for muscle treatment
9
Q
contraindications
A
- avoid lying on affected shoulder
10
Q
technique
A
- look for 1st rib subluxation (adjust clavicle, humerus, scapula)
11
Q
care plan
A
2x a week for 3 weeks
12
Q
recommendations
A
- stretch tight muscles and strengthen weak muscles
- avoid sleeping with arm above head
- reduce repetitive activities
improve posture
13
Q
prognosis
A
excellent if they stretch
