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)
2
Q
Three types of TOS
A
- Neurogenic TOS (MC, 90-95%)
- Arterial TOS
- Venous TOS (may progress ot Paget-Schroetter syndrome)
3
Q
Paget-Schroetter syndrome
A
Axillosubclavian vein thrombosis
- Effort induced thormbosis
- Occurs in patients performing repetitve mtion of the arm (pitchers, swimmers, etc)
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
5
Q
Demographics of TOS
A
- Females (4:1)
- 20-40 years of age
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)
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
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
9
Q
TOC for TOS
A
- Physical therapy (initial TOC)
- Strengthen shoulder structures
- Correct posture
- Surgical therapy
- Non-responsive to conservative management and PT
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