Thoracic Outlet syndrome

Question 1

signs and sx’s

Answer 1

• pain
• paresthesia
• weakness, coolness, heaviness in UE
• sx’s aggravated by elevation of arms, exaggerated movement of head and neck

Question 2

etiology

Answer 2

• soft tissue vs osseous

- compression- arterial, venous, neurologic

Question 3

soft tissue

Answer 3

• scalene/pectoral m restriction
• c-spine hyperflexion/hyperextension
• apical tumor of lung (Pancoast’s tumor)
• postural/structural changes- aggravated by stress or trauma

Question 4

soft tissue- postural causes

Answer 4

• short leg syndrome
• inc anterior tilt- shoulder girdle protracts
• inc post tilt- shoulder girdle protracts (compensatory)

Question 5

osseous causes

Answer 5

• prominent C7 transverse process
• cervical rib
• 1st rib abnormalities
• fracture of 1st rib w callus formation
• clavicular fractures

Question 6

diagnosis

Answer 6

• trauma hx

- pre-existing postural stressors

Question 7

-provocative tests

Answer 7

• adson’s- scalene, 1st rib
• wright’s hyperabduction- pec minor
• costoclavicular- clavicle, rib
• east test
• spurling’ test- radiculopathy

Question 8

tx- pharamocologic

Answer 8

• analgesics
• NSAID/steroids
• m relaxanat
• amitriptyline
• gabapentin

Question 9

tx- PT

Answer 9

• moist heat
• US
• electrical stimulation
• postural stretching/strengthening exercise

Question 10

tx- self-stretching

Answer 10

• scalenes
• pectoral m’s
• will exacerbate sx’s
• hold 30 sec, 10 stretches BID

Question 11

tx- m strengthening

Answer 11

• light weights/high repetition
• resistance exercises
• avoid shoulder abduction > 45

Question 12

tx- OMT

Answer 12

• CS
• HVLA
• MFR
• ME
• spray and stretch

Question 13

muscle engram

Answer 13

• m length that the m spindle and CNS recognize
• shortened in TOS
• myofascial structures stretch by plastic deformation- recoil after stretch- freq of stretch important- allows a gradual change to engram