Thoracic Outlet Syndrome Flashcards

1
Q

Definition of thoracic outlet syndrome (TOS)

A

Constellation of symptoms related to compression of the neurovascular elements foudn in the thoracic outlet (brachial plexus, SC artery, SC vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Three types of TOS

A
  • Neurogenic TOS (MC, 90-95%)
  • Arterial TOS
  • Venous TOS (may progress ot Paget-Schroetter syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Paget-Schroetter syndrome

A

Axillosubclavian vein thrombosis

  • Effort induced thormbosis
  • Occurs in patients performing repetitve mtion of the arm (pitchers, swimmers, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Etiology of TOS

A
  • Anterior scalene muscle hypertrophy
    • Brachial plexus or SC artery compression
  • Costoclavicular syndrome
    • Narrowing of the space between clavicle and 1st rib
  • Cervical rib
  • Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Demographics of TOS

A
  • Females (4:1)
  • 20-40 years of age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MC presentation of TOS

A
  • Pain
  • Numbness
  • Tingling of arm/hand
  • Arm swelling (occlusive thombus in venous TOS)
  • Distal arm/hand ischemia (arterial TOS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 clinical exam maneuvers use to elicit signs/symptoms of TOS

A
  • Costoclavicular test:
    • patient holds shoulders down and backward (narrows costoclavicular space)
  • Adson test:
    • patient takes deep breath while extending neck and turning head toward affected side (narros interscalene triangle)
  • Roos test:
    • patient holds arms at 90 degrees of abduction and external rotation with shoulders drawn back, patient hands opened and closed for 3 minutes
  • Wright test:
    • patient hyperabducts and externally rotates arms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnostic evaluation for TOS

A
  • H&P
  • X-ray (C-spine and chest)
    • Exclude cervical vertebral anomalies and cervical rib
  • CT (IV contrast) or MRI
    • Neutral position with arms above head
  • Arteriogram and/or venogram
    • Sx of arterial (digit ischemia) or venous TOS (arm swelling)
    • Not routinely performed as most patients have neurogenic TOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TOC for TOS

A
  • Physical therapy (initial TOC)
    • Strengthen shoulder structures
    • Correct posture
  • Surgical therapy
    • Non-responsive to conservative management and PT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Surgical appraoch to TOS

A
  • First rib resection with scalenectomy
    • Supraclavicular or trans-axillary approach
  • Venous TOS
    • Usual TOC: thrombolysis followed by decompression (1st rib resection and scalenectomy)
    • May require supra- and infra-clavicular incisions
    • May require venous angioplasty or reconstruction after decompression
  • Arterial TOS
    • May require arterial reconstruction in addition to 1st rib resection and scalenectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly