TOS

Question 1

What is the purpose of Allen’s test?

Answer 1

test the patency of the upper extremity arterial system

occlude each vessel to observe filling time

Question 2

what does a delayed color return with Allen’s test indicate?

Answer 2

partial blockage- normal return time is 5 seconds

Question 3

what does no color return with Allen’s test indicate?

Answer 3

complete blockage of the artery or possible occlusion of common vessel

Question 4

what is the purpose of Adson’s test?

Answer 4

test for neurovascular compression of the subclavian artery and/or brachial plexus

Question 5

what is a positive Adson’s test?

Answer 5

patient reports paresthesia and or decrease in amplitude of radial pulse

Question 6

what is a common cause of compression of the neurovascular bundle seen in a + Adson’s test?

Answer 6

hypertrophy of the scalenus anticus muscle and or cervical rib

Question 7

with a modified Adson’s test, what muscle is being tested?

Answer 7

Scalenus medius muscle or cervical rib

Question 8

with Halstead’s test, if there is a drop in amplitude of the pulse what does this mean? If there isn’t a drop what do you do next?

Answer 8

a drop in amplitude= + sign

no drop= continue with test and have patient rotate head to the opposite side

Question 9

what muscle is being tested with Halstead’s test?

Answer 9

scalenus medius and cervical rib

Question 10

with any TOS test, what should the practitioner always do first?

Answer 10

find the pulse before positioning the patient

Question 11

with Allen’s maneuver, what is a positive test and what does it indicate?

Answer 11

+ test= disappearance of pulse; indicates TOS

Question 12

What is the function of Roos’ test?

Answer 12

stress the thoracic outlet area

Question 13

what is a + Roos’ test?

Answer 13

tingling or paresthesia often in the ulnar side of the forearm and hand; 91% of TOS patients +

Question 14

what test compresses the axillary artery under the pec minor muscle?

Answer 14

Wright’s test/ hyperabduction test

Question 15

why must Wright’s test be performed bilaterally?

Answer 15

many patients have cessation of radial pulse upon abduction of the arm so unaffected side needs to be tested for comparison

Question 16

what is the purpose of the costoclavicular test/ Eden’s test?

Answer 16

narrow space btw clavicle and first rib thus compressing the neurovascular tissues of the subclavian artery, vein and brachial plexus

Question 17

what are the common causes of narrowed space btw clavicle and first rib?

Answer 17

poor posture
cervical rib
bone tumor
fracture clavicle

Question 18

what are the indications for a + Eden’s/costoclavicular test?

Answer 18

cessation or dampening of radial pulse
ischemic color changes
paresthesia
radicular pain in upper limb

Question 19

what are the possible syndromes associated with TOS?

Answer 19

cervical rib
scalene anticus and medius syndrome
costoclavicular syndrome
pectoralis minor

Question 20

what are the motor signs associated with TOS?

Answer 20

weakness and clumsiness of fingers
grip or pinch strength reduced
reflexes NORMAL
muscle atrophy- MC intrinsic muscles assoc. with C8-T1 nerve roots; less common thenar eminence

Question 21

what tends to be the first sign of TOS?

Answer 21

paresthesia

Question 22

What 2 nerves are most commonly affected with TOS?

Answer 22

ulnar and medial cutaneous nerve of forearm; can have paresthesia in all fingers but much less common

Question 23

In patients with Ulnar Nerve Syndrome, the elbow will never have sensory loss where?

Answer 23

proximal or middle portions of the forearm

Question 24

Patients with arterial insufficiency in the arm have different sx than those who have neural compression, the early signs include:

Answer 24

coldness
aching muscles
loss of strength after continued use
pale or cyanotic hands

late changes: gangrene of fingertips trophic changes in nails and skin

Question 25

what 2 tests are for cervical rib, scalene anterior and medius and sibson’s fascia?

Answer 25

Adson’s and Halstead’s

Question 26

which test is used for costoclavicular syndrome?

Answer 26

Eden’s

Question 27

which test is used for pectoralis minor syndrome?

Answer 27

Wright’s/ hyperabduction

Question 28

which test is used for arterial insufficiency?

Answer 28

Allen’s test