Thoracic Inlet II

Question 1

What are the borders of the thoracic inlet?

Answer 1

first ribs
First thoracic vertebra
Superior end of the manubrium

Question 2

What are the boundaries of the thoracic outlet?

Answer 2

Clavicles
Scapula
Root of the neck
1st rib and rib cage
Arm

Question 3

What is thoracic outlet syndrome?

Answer 3

Compression of the neurovascular bundle as it courses through the neck and shoulder

Question 4

What are the contents of the thoracic outlet?

Answer 4

Subclavian artery
Subclavian vein
Brachial plexus

Question 5

The brachial plexus emerges between which two neck muscles?

Answer 5

Anterior and middle scalene

Question 6

How does the brachial plexus lie relative to the first rib and the clavicle?

Answer 6

Deep to clavicle, Superficial to the first rib

Question 7

Where is the neurovascular bundle compressed, usually?

Answer 7

Extra cervical rib
Between the scalenes
Between the clavicle and first rib
Between pec minor and upper ribs

Question 8

What is costoclavicular syndrome?

Answer 8

Compression of the brachial plexus from the clavicle and first rib

Question 9

What is pectoralis minor syndrome?

Answer 9

Compression of the brachial plexus between the pectoralis minor and upper ribs

Question 10

What are the symptoms of TOS?

Answer 10

Shoulder or arm pain
Weakness
Paresthesia

Question 11

What are the physical findings of TOS?

Answer 11

Diminished pulses
Digital cyanosis
Hand weakness

Question 12

What is in the ddx of TOS?

Answer 12

Tumor
pseudoclaudication
vascular disease
Carpal tunnel

Question 13

What is Adson’s test? What indicates a positive test?

Answer 13

Adduct the affected arm, with fingers on the radial pulse, then turn head toward affected arm.

Positive = more symptoms

Question 14

What is the hyperabduction (Wright’s) test?

Answer 14

Raise arms above head feeling for radial pulse.

Positive for pectoralis minor syndrome

Question 15

What is the costoclavicular test?

Answer 15

Dr places hand on shoulders and pulls posteriorly. Positive for costoclavicular syndrome if there is exacerbation of symptoms

Question 16

How can OMT supposedly help TOS, in the case of an extra rib?

Answer 16

Enable that rib to be as mobile as possible by opening the inlet and thus removing obstruction around the site

Question 17

When acting as a unit, the thoracic inlet rotates and side bends how?

Answer 17

To the same side

Question 18

True or false: you can treat just the sidebending or rotational component of the thoracic inlet for full treatment?

Answer 18

False–must do both

Question 19

What is CCP for the inlet?

Answer 19

Rotated and side bent right

Question 20

What happens if there is a Type 1 SD in the thoracic outlet? (what are the “symptoms” or “findings”)?

Answer 20

Elevated first rib and a compressible infraclavicular area on the same side.

Question 21

Why do we recheck if we hear an articulation in the neck?

Answer 21

May not be a ligament problem

S/CS tender point may be the issue