thoracic outlet syndrome

Question 1

what are other names for TOS?

Answer 1

cervical rib and scalenus syndrome

costoclavicular syndrome

hyperabduction syndrome

cervicobrachial compression syndrome

Question 2

pathophysiology of TOS?

Answer 2

compression on brachial plexus(neurologic TOS)

or compression on axillary or subclavian arteries(arterial TOS; pale skin)

or compression on brachial vein(venous TOS; venous congestion and purple discoloration with venous congestion)(common in men with difficult occupations–>effort thrombosis–>PAGET-SCHROETTER syndrome)

Question 3

what innervates the anterior scalene muscle?

Answer 3

phrenic nerve

Question 4

risk factors of TOS?

Answer 4

enlarged clavicle or first rib bone

heavy lifting in gym

scoliosis

breast implant or hypertrophy

repetitive hand movements at work/office

scalene muscle hypertrophy

congenital ligaments

Question 5

what is the most common symptom of TOS?

Answer 5

paresthesia; compression of artery–pins and needles sensation due to ischemia

Question 6

C7–???
C4–???
C4-C7=???
T1–arms will ???

Answer 6

C7=arm
C4=hand
C4-7=occipital headache
T1=arms will weaken and be atrophied long term+paresthesia

Question 7

which of the venous or arterial system can create collateral new vessels??

Answer 7

venous system,
bcz in arterial TOS the cell will necrotize by the time new vessels form

Question 8

what is claudication?

Answer 8

phenomenon in TOS when the pt wants to relieve pain due to compression on arterial supply to relieve paresthesia and let the blood pass

Question 9

What are the differential diagnosis of TOS

Answer 9

Cervical disc syndrome

Carpal tunnel syndrome

Cubital tunnel syndrome

Orthopeedic should disorder;scoliosis

Cervical radiculopathy

Ulnar nerve compression

Multiple sclerosis

(Spinal cord tumors

Pancoast tumors

Stable angina)

Reflex sympathetic dystrophy

Raynaud’s phenomenon

Question 10

What is the test performed to detect TOS?

Answer 10

Adson’s test(scalene maneuver)

Halsted test

Hyperabduction test(wright test)

Roos test(elevated arm test)

Question 11

What are the definitive objective tests to diagnose TOS?

Answer 11

X ray

Doppler USG

Arteriography

Thorax CT

MRI

EMG

Nerve conduction study

Question 12

What is raynaud’s phenomena?

Answer 12

Vasospastic disorder that increases with cold and stress

Question 13

Treatment for TOS?

Answer 13

Conservative treatment: change occupation , correct posture, lose weight, Pilates or physical therapy+pain killers

Surgical;in case of thrombosis: decompression by transaxillary(arterial TOS) or infraclavicular or supraclavicular route