Thoracic Outlet Syndrome Flashcards
Definition
symptom complex characterized by pain, paresthesia, weakness, & discomfort in UL, agg by elevation of arms &/or exaggerated head/neck movements
True neurogenic TOS
brachial plexus injury, confirmed by NCV/EMG.
True vascular TOS
subclavian artery/vein injury or dysfunction, confirmed by imaging.
Nonspecific/Disputed TOS
symptoms but no abnormal tests to document lesion.
Possible sites of compression
scalene triangle
costoclavicular space
coracopectoral space
Scalene Triangle borders
Ant scalene (TP C3-6 to rib 1) Mid scalene (TP C2-7 to rib 1) Rib 1
Scalene Triangle contents
Brachial plexus trunks
Subclav artery
Costoclavicular borders
Clavicle
Rib 1
Costoclavicular contents
Brachial plexus trunks
Subclav artery
Subclav vein
Coracopectoral borders
Coracoid
Pec minor
Ribs 2-4
Coracopectoral contents
Brachial plexus cords
Axillary artery
Axillary vein
Causes: congenital abnormalities
Cervical rib” - rib remnant at C7, super long TP.
Fibrous or muscular anomaly.
Causes: post-trauma
Clavicle fx.
Soft-tissue injury, whiplash.
Causes: functional
Hypertrophic muscles (ADLs, training, breathing).
Fwd head - shld protraction & SCM shortening at first, then scalene & pec min shortening if advanced.
Narrowed costoclavicular space, ribs 1-5 elevated.
Compression at all 3 sites.
Causes: other
tumors, hyperostosis (bone overgrowth), osteomyelitis.
Clinical presentation Venous
swelling, cyanosis, changes in temp.
Clinical presentation Arterial
ischemia w/ effort, Raynauds, cold limbs.
Clinical presentation Neurologic
Thenar, hypothenar, & interossei weakness/atrophy.
Ulnar & medial antebrachial cutaneous nerve numbness.
Fatigue in UE.
Vague, poorly defined, inconsistent symptoms.
What structures have been lengthened/shortened/altered
Post musc have been lengthened (need to be strengthened).
Ant musc have been shortened (need to be stretched).
Scap is down rotated.
Treatments
Posture
Stretch: scalenes, pec min, upper traps.
Strengthen: serratus ant, mid/low traps, low back extensors, triceps, lats.
Mob: clavicle, C-spine, 1st rib, scapula.
