Thoarcic Otulet Syndrome

Question 1

What is the MOI?

Answer 1

1. Idiopathic compression of *** as they exit the narrowed space between shoulder girdle and first rib
   *brachial plexus (95%)
   *subclavian vein (5%)
   *subclavian artery (1%)

Question 2

What are the nerve compression symptoms?

Answer 2

1. Pain/Paresthesias to forearm, arm, and or ulnar side of hand

Question 3

What are the vascular compression symptoms?

Answer 3

1. Swelling/discoloration of arm especially with abduction of arm

Question 4

What will be on the PE?

Answer 4

1. +Adson
   *loss of radial pulse with head rotated to affected side
   *arm abducted at 30 degrees and maximally extended
   *radial pulse palpated and examiner grasps patients website
   *patient extends neck and turns head towards to symptomatic shoulder takes breath and holds

Question 5

What is the management?

Answer 5

1. Controversial
2. PT first line, avoid strenuous activity
3. Orthopedic consult +/- surgery
   *will remove first services rib