TOS

Question 1

What is TOS a result of?

Answer 1

COMPRESSION OF NEUROVASCULAR BUNDLE

causing decreased circulation / pain

Question 2

What makes up the neurovascular bundle?

Answer 2

BRACHIAL PLEXUS
\+
SUBCLAVIAN VEIN
\+
SUBCLAVIAN ARTERY

Question 3

The brachial plexus originates at _____ - T1, enter between _________ and __________ scalenes, goes ________ the clavicle, over the _________, and ________ the corocoid process posterior to pec minor.

Answer 3

C5 - T1
b/t ANTERIOR and MIDDLE
UNDER the CLAVICLE
OVER the 1st RIB
UNDER

Question 4

List the 6 possible causes of TOS?

not important just fyi

Answer 4

1. Cervical rib
2. Reduced inter-scalene triangle
3. Decreased costoclavicular space
4. Decreased costocoracoid space
5. Decreased space from shoulder droop
6. Callus formation from clavicular fracture

Question 5

What are the 6 Special Tests for TOS?

Answer 5

1. ADSON’S MANEUVER
2. TRAVELL’S VARIATION / HALSTEAD MANEUVER
3. MILITARY STANCE / COSTOCLAVICULAR SYNDROME TEST
4. WRIGHT’S HYPERABDUCTION TEST
5. ROOS TEST / ELEVATED ARM STRESS TEST
6. ALLEN’S TEST FOR THE SHOULDER

Question 6

What are the first 3 Special Tests for TOS?

Answer 6

1. ADSON’S MANEUVER
2. TRAVELL’S VARIATION / HALSTEAD MANEUVER
3. MILITARY STANCE / COSTOCLAVICULAR

Question 7

What are the final 3 Special Tests for TOS?

Answer 7

4. WRIGHT’S HYPERABDUCTION TEST
5. ROOS TEST / ELEVATED ARM STRESS TEST
6. ALLEN’S TEST FOR THE SHOULDER

Question 8

How do you perform Adson’s Maneuver (#1), testing TOS compromise between anterior and middle scalenes?

Answer 8

PALPATE RADIAL PULSE
+
EXTEND SHOULDER APPLYING DOWNWARD TRACTION
+
ASK PATIENT TO TAKE DEEP BREATH AND HOLD
while
ACTIVELY EXTENDING and IPSILATERALLY ROTATING NECK

+ = diminished pulse, reproduction s / s

Question 9

How do you perform Travell’s Variation / Halstead Maneuver (#2), testing TOS compromise of scalenes?

Answer 9

PALPATE RADIAL PULSE
+
EXTEND SHOULDER APPLYING DOWNWARD TRACTION
+
ASK PATIENT TO TAKE DEEP BREATH AND HOLD
while
ACTIVELY EXTENDING and CONTRALATERALLY ROTATING NECK

+ = diminished pulse, reproduction s / s

Question 10

How do you perform Costoclavicular Syndrome Test / Military Stance (#3), testing TOS compromise between clavicle and first rib?

Answer 10

PALPATE RADIAL PULSE
\+
ASK PATIENT TO STAND WITH SHOULDERS DOWN AND BACK IN EXAGGERATED MILITARY STANCE
\+
GET PATIENT TO TAKE DEEP BREATH

+ = diminished pulse, reproduction s / s

Question 11

How do you perform Wright’s Hyperabduction Test (#4), testing TOS compromise of pec minor?

Answer 11

PALPATE RADIAL PULSE
\+
ASK PATIENT TO TAKE DEEP BREATH AND HOLD
\+
PASSIVELY FULLY ABDUCT PATIENTS ARM (stabilize, not allowing elevation)

+ = diminished pulse, reproduction s / s

Question 12

How would you perform Roos Test / Elevated Arm Stress Test?

Answer 12

90° G-H ABDUCTION
\+
EXTERNALLY ROTATED
\+
FLEX ELBOWS TO 90°
\+
SLOWLY OPEN / CLOSE HAND FOR 3 MINUTES

Question 13

How would you perform Allen’s Test for the shoulder?

Answer 13

90° G-H ABDUCTION
\+
FLEX ELBOWS TO 90°
\+
THERAPIST PALPATES RADIAL PULSE
\+
PATIENT CONTRALATERALLY ROTATES HEAD