Thoracic OUTLET syndrome

Question 1

Thoracic OUTLET

Answer 1

compression of the subclavian a.

lateral cord of the brachial plexus between scalenes and first rib

Question 2

CC of TOS

Answer 2

Arm and shoulder pain

numbness in the 4/5 digits - must differentiate other possible fingers

ulnar n affected

coldness of hand with abduction

Question 3

How can you differentiate TOS (at neck) from other injuries?

Answer 3

use MRI to see if its from the cervical spine (nerve root)

Question 4

Hx of TOS

Answer 4

progressive development

Congenital - anolamous first rib

fx of the clavicle - trauma

clavicular malunion

Last cervical vertebrae can be enlarged and compress rib

Question 5

Adson’s maneuver test

Answer 5

TOS physical finding

loss of pulse in abduction

Question 6

Physical findings of TOS

Answer 6

Numbness of 4/5 digits

positive adson’s maneuver test

pain

Question 7

Objective findings for TOS

Answer 7

EMG - test nerve conduction of ulnar n

Vascular studies - invasive - can be done for better visualization (see if the subclavian a. is narrow) = use dye to see the arterial flow on arteriogram

Question 8

Which objective finding of TOS not invasive?

Answer 8

noninvasive vascular - ultrasound?

EMG

Question 9

Invasive vascular finding of TOS

Answer 9

Inject dye and see the subclavian a and vertebral a going up to the head

Question 10

Tx of TOS

Answer 10

PT

Meds

surgery - but AVOID WHEN POSSIBLE