Thoracic Outlet Syndrome

Question 1

Definition

Answer 1

symptom complex characterized by pain, paresthesia, weakness, & discomfort in UL, agg by elevation of arms &/or exaggerated head/neck movements

Question 2

True neurogenic TOS

Answer 2

brachial plexus injury, confirmed by NCV/EMG.

Question 3

True vascular TOS

Answer 3

subclavian artery/vein injury or dysfunction, confirmed by imaging.

Question 4

Nonspecific/Disputed TOS

Answer 4

symptoms but no abnormal tests to document lesion.

Question 5

Possible sites of compression

Answer 5

scalene triangle
costoclavicular space
coracopectoral space

Question 6

Scalene Triangle borders

Answer 6

Ant scalene (TP C3-6 to rib 1)
Mid scalene (TP C2-7 to rib 1)
Rib 1

Question 7

Scalene Triangle contents

Answer 7

Brachial plexus trunks

Subclav artery

Question 8

Costoclavicular borders

Answer 8

Clavicle

Rib 1

Question 9

Costoclavicular contents

Answer 9

Brachial plexus trunks
Subclav artery
Subclav vein

Question 10

Coracopectoral borders

Answer 10

Coracoid
Pec minor
Ribs 2-4

Question 11

Coracopectoral contents

Answer 11

Brachial plexus cords
Axillary artery
Axillary vein

Question 12

Causes: congenital abnormalities

Answer 12

Cervical rib” - rib remnant at C7, super long TP.

Fibrous or muscular anomaly.

Question 13

Causes: post-trauma

Answer 13

Clavicle fx.

Soft-tissue injury, whiplash.

Question 14

Causes: functional

Answer 14

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.

Question 15

Causes: other

Answer 15

tumors, hyperostosis (bone overgrowth), osteomyelitis.

Question 16

Clinical presentation Venous

Answer 16

swelling, cyanosis, changes in temp.

Question 17

Clinical presentation Arterial

Answer 17

ischemia w/ effort, Raynauds, cold limbs.

Question 18

Clinical presentation Neurologic

Answer 18

Thenar, hypothenar, & interossei weakness/atrophy.
Ulnar & medial antebrachial cutaneous nerve numbness.
Fatigue in UE.
Vague, poorly defined, inconsistent symptoms.

Question 19

What structures have been lengthened/shortened/altered

Answer 19

Post musc have been lengthened (need to be strengthened).
Ant musc have been shortened (need to be stretched).
Scap is down rotated.

Question 20

Treatments

Answer 20

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.