SM 248a - Limb Vasculature: Clinical Cases Flashcards
Describe the presentation of venous thoracic outlet syndrome
Upper extremity:
- Swelling
- Cyanosis
- Heaviness
- Pain
- Unilateral Raynaud’s syndrome
Describe the presentation of popliteal artery entrapment
- Intermittent calf or foot claudication
- +/- coldness, numbness, paresthesias
- Pain at rest is not common
-
Younger, athletic patients
- vs. older, more sedentary in peripheral artery disease
What is ROOS test?
What constitutes a positive test?
What do the results indicate?
- Patient in this position (pictured)
- Open and close fists for at least 2 minutes
- Encourage patient to report symptoms
-
Postiive test
- Pain
- Fatigue
- Numbness
- Tingling
Sensitive, but not specific for thoracic outlet syndrome
Which of the following signs symptoms are typically associated with venous thoracic outlet syndrome?
- Neurologic changes
- Swelling
- Paresthesias
- Increased warmth
b. Swelling
What causes venous thoracic outlet syndrome?
- Subclavian vein compression
- Mechanical compression and repetitive injury of the subclavian vein
What is the treatment for a Baker’s (popliteal) Cyst?
- Leg edema resolves over daysàweeks
- Treated with analgesics
- Can inject knee or bursa with glucocorticoids
Describe the presentation of PAD
- Usually no pain at rest
- Pain is worse with exertion
- Usually presents in older, more sedentary patients
- vs. young, athletic patients in popliteal artery entrapment
What is a Baker’s Cyst?
Fluid-filled distention of a preexisting bursa in the medial popliteal fossa
Valve-like mechanism through an opening in the joint capsule posterior to the medial femoral condyle contributes to formation
What tests are used to test for popliteal artery entrapment?
- Ankle-brachial index
- Ratio of blood pressure at the ankle to blood pressure at the arm
- ≤0.9 is abnormal
- Ultrasound with doppler
- MRI/MRA
- Angiography
What causes arterial thoracic outlet syndrome?
Subclavian artery compression within the costoclavicular space
- Anomalous 1st rib
- Entrapment between the pectoralis minor and humeral head
Compression -> intimal damage -> turbulent flow -> vessel dilation
Ischemia
What causes arterial thoracic outlet syndrome?
Physical therapy
Change posture or activities that bring on symptoms
Surgery when neurologic changes affect function, or vascular changes lead to ischemia or substantial symptoms
What mechanisms might cause thoracic outlet syndrome?
- Trauma
- Repetitive motions
- Anatomic variations
- Tumors
- Large lymph nodes
- Injury to the neck or back
- Poor posture
What are the most useful distinguishing feature in the presentations of popliteal artery entrapment vs. peripheral artery disease?
Age and health of the patinet
- Young, athletic, healthy = most likely popliteal artery entrapment
- Older, sedentary = most likely peripheral artery disese
- Especally people who smoke
What are the most common symptoms of neurogenic thoracic outlet syndrome?
- Upper limb paresthesias
- Trapezius pain
- Neck pain
- Shoulder/arm pain
- Supraclavicular pain
- Occipital headache
- Chest pain
Describe the presentation of a ruptured Baker’s (popliteal) cyst
- May be asymptomatic
- Can ruptrure without previous knee pain
- Mild-moderate leg edema +/- bruising
- May be difficult to palpate
- Older individual
- Most worrysome complication:
- Compression of the popliteal artery/vein
- -> Ischemia or thrombosis
Which type of thoracic outlet syndrome does this patient most likely have?
Venous thoracic outlet syndrome
Swelling, cyanosis, heaviness, pain of the upper extremity
