Thoracic Outlet syndrome

Question 1

What is thoracic outlet syndrome (TOS)

Answer 1

• compression of the NV bundle
• difficult culster of symptoms to diagnosis - diagnosis of exclusion

Question 2

incidence of TOS

Answer 2

• 3-80 cases per 1000 people
• age at onset 20-50 years
• 3 times more common in females

Question 3

TOS types diagnosis

Answer 3

• Neurogenic TOS -true TOS: can be confirmed with anatomic anomaly with a test
• Nonspecific “symptomatic” neurogenic TOS: pressure is more on nerves
• Vascular syndromes-arterial
• vascular syndromes- venous

Question 4

What is the most common cause of symptoms of TOS

Answer 4

• brachial plexus: 95% (C8-T1 is most common)
• subclavian vein 4%
• subclavian artery 1%

Question 5

Where is the entrapment most likely to occur with TOS

Answer 5

• interscalene triangle (not subclavian as this comes anterior) scalene syndrome
• costocalvicular triangle: mid-clavicle, 1st rib and upper border of scapula (bad posture) 1st rib syndrome
• subcoracoid space = pectoralis minor syndrome (rounded shoulders/poor posture/heavy weight lifting)

Anomalies:

• cervical rib anomaly (C7 TP)
• fibrous bands/scarring can connect TP and restrict Neurovascular bundle
• clavicular fracture malunion
• degnerative changes

Question 6

Neurological symptoms with TOS

Answer 6

• paresthesia’s nocturnal awaken with symptoms
• pain
• weakness
• loss of dexterity
• cold intolerance

Question 7

vascular symptoms with TOS

venous

Answer 7

• pain with strenuous UE work
• edmea and cyanosis
• distended veins shoulder/chest

Question 8

Vascular symptoms with TOS

arterial

Answer 8

• pain with vigorous activities
• pallor or pulselessness
• coolness
• decreased BP in extremity

Question 9

Thoaracic outlet causes

Answer 9

• postural/postural stresses
• anatomic: acuired/anomaly
• traumatic or cumulative

Question 10

Thoracic outlet syndrome examination

Answer 10

clinical examination

• adsons
• Roos (EAST) elevated arm stress test

diagnostic tests

• radiographs
• arteriogram
• venogram
• nerve conduction
• MRI
• CT

Question 11

TOS interventions (PT)

Answer 11

• Relive compression
• stretch scalenes
• mobilize 1st rib
• stretch pectoralis minor
• correct posture
• pt have to understand as it may cause symptoms during treatment

Question 12

TOS surgical interventions

Answer 12

• release scalenes
• remove 1st rib
• mobilize nerves/blood vessels
• Botulinum toxin (Botox)