Thoracic Outlet Flashcards
Anatomical container region contains the interscalene triangle - list borders & contents?
Anterior scalene
Middle scalene
Medial surface of 1st rib
Contains - trunks of brachial plexus, subclavian artery
(note: subclavian vein runs beneath ant. scalene)
Anatomical container region contains the costoclavicular space - list borders & contents?
Middle third of clavicle
First rib
upper border of scapula
Contains - trunks of brachial plexus, subclavian artery & vein
( an area of potential probs with clavicular injury, may get subclavian vein obstruction)
Anatomical container region contains the thoraco-coraco-pectoral space - list borders & contents?
corocoid process
pectoralis minor
ribs 2-4
Contains - cords of brachial plexus, axillary artery & vein (continuations of subclavian)
Compression in scalene triangle vs compression in CC & thoraco-coraco-pectoral space
Different symptoms - what are they?
Scalene triangle -
occipital HAs
sig. neck pain due to trauma to scalene muscles
CC & TCP space -
HAs & neck pain are minimal
Cervical ribs & anomalous 1st ribs……..
Are they common? Classification?
What type of TOS due they generally cause?
Cervical ribs - more common in women, occur in just under 1% of people, lie in the middle scalene
Complete - attach to 1st rib by joint or fusion
Incomplete - have a tight thick lig. connecting to 1st rib
Anomalous 1st ribs - congenital, thinner, sit higher & usually fuse to 2nd rib rather than sternum.
Either an cause ATOS (subclavian compression) & NTOS compression
Brachial Plexus
The 3 Muskateers………
The 3 Muskateers, Assasinated 5 Rats, 5 Mice and 2 Unicorns
Musculocutaneous, Axillary, Radial, Median, Ulnar
Hold up your hand, Thumb is C5 down to little finger being T1,gives you nerve roots of above nerves
Who is more likely to get Thoracic Outlet Syndrome?
Women are 3-4 times more likely to develop neurogenic
Men & women equal for vascular
What is ‘true’ and what is ‘disputed’ TOS?
What symptoms happen with both?
(note - Neurogenic TOS is hard to diagnose as could be peripheral nerve entrapment, both present with same symptoms)
True is confirmed through positive neurophysiologial testing, can have numbness during the day
Compressors - symptoms worse during day
Disputed - not confirmed & can have numbness at night
releasers - symptoms worse at night
Both - common hx of neck trauma
pain, paresthesia, numbness &/or weakness in hand/arm (C8/T1 distrib), shoulder, neck pain, occipital HAs, loss of dexterity, Raynauds
Symptoms of arterial thoracic outlet syndrome
Pain, numbness in a non-radicular distrib.
cool to touch, pale
All of above gets worse the colder it gets
Symptoms of neurogenic thoracic outlet syndrome
pain, paresthesia, numbness &/or weakness
examiner should at this point look for symptoms being radicular or non radicular
TOS will normally not produce symptoms that follow dermatomal & myotomal patterns unless it is accomp. by cervical or upper thoracic nerve root compression
Symptoms of venous thoracic outlet syndrome
excruciating deep pain in the chest, shoulder & entire upper extremity with a feeling of heaviness after activity
cyanotic discolouration
distended collateral veins & possible odema in extremity
Thoracic Outlet Syndrome can produce symptoms outside of the upper extremity - where?
Compression/irritation of the upper plexus (C5/6/7) can cause pain in the ant. neck from clavicle to mandible, ear, mastoid area, sometimes into side of face, upper chest, down to radial nerve distribution
What is a releaser?
a patient that experiences a release phenomenon (release of tension or compression to thoracic outlet) that often awakes them at night
What is a compressor?
a patient that experiences symptoms throughout the daytime while using prolonged postures resulting in increased tension or compression of the thoracic outlet
What is an objective test for true NTOS?
Nerve conduction velocity test
