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TOS Flashcards

1
Q

WHAT IS TOS

A

Neuromuscular compression/compromise of brachial plexus/or subclavian-axillary vessels as they exit thoracic cavity and enter UE

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2
Q

Neurologic TOS

A

MC lower truck (c8/T1)

  • due to abnormal nerve stretch or compression
  • MC in women with drooping shoulders
  • starts medially and moves lateral
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3
Q

Type of TOS most common in women with drooping shoulders

A

Neurologic

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4
Q

Vascular tOS

A

Involved subclavian artery and vein

  • may see unilateral arm swelling
  • MC in men
  • position may help
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5
Q

MC type of TOS in men

A

Vascular

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6
Q

S/s of vascular TOS

A

Decreased capillary refill
Diminished pulse
Cold extremity
Cyanosis/white

DDX: raynauds

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7
Q

Reasons for creating of pressure in TOS

A
  • 1st rib creates floor for compression
  • traps brachial plexus and subclavian vessels between ribs and other structures
  • clavicle
  • pec minor
  • scalene
  • cervical ribs
  • elongated c7 TVP
  • subclavius hypertrophy
  • bony callous/exostosis
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8
Q

What are the four outlets possible for TOS

A
  1. Sternocostovertebral space
  2. Scalene triangle
  3. Costoclavicular space
  4. Coracopectoral space
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9
Q

What makes up the sternocostovertebral space

A

Sternum
Spine
First rib

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10
Q

What makes up the scalene triangle

A

Anterior, middle scalene and first rib

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11
Q

Costoclavicular triangle-what is it made of?

A

Clavicle
First rib
Subclavian muscle

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12
Q

What makes up for coraco pectoral space

A

Coracoid process

And pec minor

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13
Q

Classic presentation of TOS

A
  • diffuse arm symptoms
  • pain/numbness/tingling
  • often path down to 4/5th digits
  • weak grip strength
  • worse with overhead activity
  • MC lower plexus c8-T1
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14
Q

Causes of TOS

A 
Trauma
Posture-rounded shoulders
Tight scalene
Tight pectoralis
Cervical ribs (RARE -1:1000)
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15
Q

To manage TOS what would you strentch and what strengthen

A

Stretch: pecs and scalene
Strengthen: rhomboid/ middle/lower traps, deep neck flexors

Can tape or brace for proprioceptive training/postural correction

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16
Q

What artery runs between scalene muscles and then it becomes _____ and then _____

A

Subclavian becomes axillary and then brachial

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17
Q

The brachial artery (originally subclavian A…axillary…) branches at the cubical fossa into ____ and ____ arteries

A

Ulnar and radial

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18
Q

Radial artery runs between what muscles

A

Brachioradialis and flexor carpi radialis

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19
Q

The radial artery runs between what muscles

A

Brachioradialis and flexor carpi radialis

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20
Q

What artery lies under flexor carpi ulnaris

A

Ulnar

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21
Q

Where does the ulnar artery lie

A

Under flexor carpi ulnaris

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22
Q

Why is blood supply to hand even if one is occluded

A

They form an anastomoses—deep and superficial palmar arches

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23
Q

What are the 4 articulations within the shoulder

A

GH
AC
SC
ST (scapulothoracic)

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24
Q

Most common cause of shoulder pain in adults

A

Subluxation
Subacromial impingement syndrome
Rotator cuff issues

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25
How will shoulder ROMs be affected by rotator cuff tear? Adhesive capsulitis?
-AROM diminished Both AROM/PROM diminished
26
Normal ROM of shoulder ``` Flexion Extension Abduction Adduction External rotation Internal rotation ```
``` Flexion: 180 Extension: 50 Abduction: 180 Adduction: 50 External rotation: 90 Internal rotation : 90+ ```
27
Muscles that comprise rotator cuff
SITS Supraspinatous Infraspinatous Teres minor Subscapularis
28
Function of supraspinatous
Abduct arm
29
Function of infraspinatous
External rotation
30
Function of teres minor
External rotation/ lateral rotation
31
Function of subscapularis
Internal rotation/aka medial rotation
32
Pneumonic to remember actions of SITS muscles
SITS ALL morning A: abduct L L: lateral rotation/external rotation M: medial rotation/internal rotation
33
MC place for rotator cuff injuries and MC complaint
Supraspinatous (abduct arm) Issues with overhead activities Increased risk of tear after 40
34
Supraspinatus passes beneath _____ and inserts on ____ ____ of ____ passing beneath ____ ____ that forms a fibrous arch over the tendon
Acromion Greater tubercle of humerus Coracoacromial ligament
35
Causes of impingement/tendinitis/bursitis
Bursa inflammation - inflammation of R.C. tendon - ca+ deposits within R.C. tendons due to wear/tear
36
S/s of impingement/tendinitis/bursitis
Achy pain worse with activity | -often radiation of biceps area in front of upper arm
37
Where might an impingement be found
Supraspinatous Biceps tendon Subacromial bursa
38
History in patients with R.C. impingement
Sports with overhead repetitive motions Baseball, volleyball, tennis, CrossFit, swimming, electricians, painters etc
39
MC space for impingement in older adults
Subacromial space Pain and tenderness at ANTERIOR JOINT Usually associate with degenerative changes
40
Tx for impingement
``` Ice Rest from aggravating activity Myofascial release Crossfriction massage Stretch posterior capsule S-I adjustment of GH ```
41
Supraspinatus tendiopathy cause
Repeated abduction of shoulder leading to impingement of supraspinatus tendon within narrow space MC tendinopathy in the UE
42
Supraspinatus tear MC in? And s/s?
Elderly (men 60+) | S/s similar to chronic subacromial impingement
43
S/s of incomplete vs complete supraspinatous tear
Imcomplete: cause of painful arc syndrome Complete: impairs ability to abduct shoulder - pain at tip of shoulder and down into UE - tenderness below margin of acromion
44
Painful arc syndrome seen when
Incomplete supraspinatous tear
45
Painful arc syndrome
Pain midrange of shoulder abduction -70-11 degrees
46
If painful arc syndrome is felt during AROM but not PROM indicates....?
Muscle/tendon issue
47
Where is subacromial bursa located
Between acromion process and greater tubercle of humerus
48
S/s of subacromial bursitis
- anterior/lateral shoulder pain - overhead lifting aggravates - pain worse at night
49
Cause of subacromial bursitis
``` Trauma Repetitive movements Inflamed joint: arthritis, gout, high inflammatory diet Overload Increased risk with age ```
50
What is biciptial tendinitis
Inflammation of the long head of biceps tendon
51
Long head of biceps tendon runs through where and what restrains it
Bicipital groove | Transverse numeral ligament restrains
52
Who’s at risk for bicipital tendonitis
Swimming, gymnastics, sports involving throwing (follow through) and occupations with overhead shoulder work or heavy lifting
53
S/s of bicipital tendonitis
- pain in anterior shoulder (over bicipital groove) occasionally radiating down to elbow - overhead activities reproduce pain (especially abduction/ext. rotation ) aka cocking arm to throw
54
Pain where in impingement syndrome of infraspinatous and teres minor
Recall they’re the lateral/external rotators Pain in posterolateral aspect
55
All actions of subscapularis
Medially rotate and depress humerus at GH joint
56
When does shoulder instability occur
When head of humerus dislocates from glenoid fossa
57
Shoulder laxity
In swimmer and throwing athlete. Loose enough to allow excessive external rotation
58
Shoulder instability
Unwanted translation of numeral head on glenoid Mc moves anterior and inferior
59
Anterior inferior shoulder dislocation
MC in younger after indirect trauma with arm abducted, extended and externally rotated
60
Posterior shoulder dislocation
Rare | Direct driving force against lower end of humerus with arm flexed forward
61
Clinical findings with posterior shoulder dislocation
Decreased fullness of numeral head in anterior and increased in posterior. Swelling masks Flatter appearance of shoulder and elbow faces out
62
Complications of shoulder instability/dislocation in younger people
Ligament or muscle gives away | Often transverse tear across capsule
63
Complications from shoulder instability/dislocation in older people
Ligaments become more firm...may cause avulsion fracture because bone less strong
64
Complications to humerus head in shoulder dislocation
Compression/impaction fracture of posterolateral aspect of humeral head Hill-Sachs lesion/hatchet deformity
65
What does glenoid labrum do
Increase surface area Increase depth/concavity Decrease translation Key role in GH stability
66
In younger people the tensile strength of the labrum is ____ than the capsule, so ____ prone to injury when _____ stress applied to GH joint
Less More Anterior
67
Bankart lesion
Anteroinferior labrum torn “Bottom” MC with anterior traumatic dislocation Detached from 3-7 o’clock Results in bother anterior and posterior structural injury Stability of inferior GH ligament lost
68
SLAP lesion
Superior labrum anterior and posterior Labrum detaches from 10-2 position Often due to FOOSH injury, deceleration when throwing or sudden traction to biceps
69
What leads to SLAP lesion
Deceleration when throwing FOOSH injury Sudden traction to biceps
70
Type 1 SLAP lesion
Superior labrum markedly frayed but attachments intact
71
Type 2 SLAP lesion
Superior labrum has a small tear Instability of labrum-biceps complex ***
72
What type of SLAP lesion is MC
Type 2 Small tear in superior labrum and instability of labradoodles-biceps complex
73
What type of SLAP lesion causes instability of labrum-biceps complex
Type 2
74
Type 3 SLAP lesion
Bucket-handle tear of labrum that may displace into joint Labrum biceps attachment intact
75
What type of SLAP lesion causes bucket-handle tear
Type 3
76
Type 4 SLAP lesion
Bucket-handle tear of labrum that extends into biceps tendon allowing tendon to sublux into joint
77
Superior labrum markedly frayed by attachments intact
Type 1 sLAP lesion
78
Superior labrum has a small tear and instability of labral-biceps complex
Type 2 slap lesion
79
Bucket-handle tear of labrum that may displace into joint | Labral biceps attachment intact
Type 3 slap lesion
80
causes of shoulder instability/dislocation
Repetitive strain—looser ligaments due to repetitive overhead motion - naturally looser ligaments in all directions - trauma
81
Humeral head injury
Compression/impaction fraction of posterolateral aspect of humeral head
82
Complications of humeral head injury
Hill-Sachs lesion/hatchet deformity
83
Hill-Sachs lesion/hatchet deformity seen when
Humeral head injury
84
Bankart lesion seen with which dislocation
Anterior GH
85
cause of AC injury
Fall or blow to lateral acromion
86
S/s of AC injury
Pain in superior/lateral shoulder during cross-arm test (abduct arm across chest)
87
What test can you do you differentiate impingement from AC?
Cross arm test.
88
Adhesive capsulitis MC in?
Older adults
89
What causes adhesive capsulitis
Idiopathic Minimal trauma MC in diabetic patients
90
S/s of adhesive capsulitis
Achy pain similar to impingement Decrease in PROM and AROM Cannot see on X-ray
91
S/s of OA
Pain/stiffness similar to adhesive capsulitis Achy pain awakens at night AROM/PROM decreased Can see on X-ray!!!***

NMS (12 decks)

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