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NMS > TOS > Flashcards

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
Q

How will shoulder ROMs be affected by rotator cuff tear? Adhesive capsulitis?

A

-AROM diminished

Both AROM/PROM diminished

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26
Q

Normal ROM of shoulder

Flexion
Extension
Abduction
Adduction
External rotation
Internal rotation
A 
Flexion: 180
Extension: 50
Abduction: 180
Adduction: 50
External rotation: 90
Internal rotation : 90+
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27
Q

Muscles that comprise rotator cuff

A

SITS

Supraspinatous
Infraspinatous
Teres minor
Subscapularis

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28
Q

Function of supraspinatous

A

Abduct arm

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29
Q

Function of infraspinatous

A

External rotation

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30
Q

Function of teres minor

A

External rotation/ lateral rotation

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31
Q

Function of subscapularis

A

Internal rotation/aka medial rotation

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32
Q

Pneumonic to remember actions of SITS muscles

A

SITS ALL morning

A: abduct
L
L: lateral rotation/external rotation
M: medial rotation/internal rotation

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33
Q

MC place for rotator cuff injuries and MC complaint

A

Supraspinatous (abduct arm)

Issues with overhead activities

Increased risk of tear after 40

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34
Q

Supraspinatus passes beneath _____ and inserts on ____ ____ of ____ passing beneath ____ ____ that forms a fibrous arch over the tendon

A

Acromion
Greater tubercle of humerus
Coracoacromial ligament

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35
Q

Causes of impingement/tendinitis/bursitis

A

Bursa inflammation

  • inflammation of R.C. tendon
  • ca+ deposits within R.C. tendons due to wear/tear
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36
Q

S/s of impingement/tendinitis/bursitis

A

Achy pain worse with activity

-often radiation of biceps area in front of upper arm

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37
Q

Where might an impingement be found

A

Supraspinatous
Biceps tendon
Subacromial bursa

38
Q

History in patients with R.C. impingement

A

Sports with overhead repetitive motions

Baseball, volleyball, tennis, CrossFit, swimming, electricians, painters etc

39
Q

MC space for impingement in older adults

A

Subacromial space

Pain and tenderness at ANTERIOR JOINT

Usually associate with degenerative changes

40
Q

Tx for impingement

A 
Ice
Rest from aggravating activity
Myofascial release
Crossfriction massage
Stretch posterior capsule
S-I adjustment of GH
41
Q

Supraspinatus tendiopathy cause

A

Repeated abduction of shoulder leading to impingement of supraspinatus tendon within narrow space

MC tendinopathy in the UE

42
Q

Supraspinatus tear MC in? And s/s?

A

Elderly (men 60+)

S/s similar to chronic subacromial impingement

43
Q

S/s of incomplete vs complete supraspinatous tear

A

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
Q

Painful arc syndrome seen when

A

Incomplete supraspinatous tear

45
Q

Painful arc syndrome

A

Pain midrange of shoulder abduction

-70-11 degrees

46
Q

If painful arc syndrome is felt during AROM but not PROM indicates….?

A

Muscle/tendon issue

47
Q

Where is subacromial bursa located

A

Between acromion process and greater tubercle of humerus

48
Q

S/s of subacromial bursitis

A
  • anterior/lateral shoulder pain
  • overhead lifting aggravates
  • pain worse at night
49
Q

Cause of subacromial bursitis

A 
Trauma
Repetitive movements
Inflamed joint: arthritis, gout, high inflammatory diet
Overload
Increased risk with age
50
Q

What is biciptial tendinitis

A

Inflammation of the long head of biceps tendon

51
Q

Long head of biceps tendon runs through where and what restrains it

A

Bicipital groove

Transverse numeral ligament restrains

52
Q

Who’s at risk for bicipital tendonitis

A

Swimming, gymnastics, sports involving throwing (follow through) and occupations with overhead shoulder work or heavy lifting

53
Q

S/s of bicipital tendonitis

A
  • 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
Q

Pain where in impingement syndrome of infraspinatous and teres minor

A

Recall they’re the lateral/external rotators

Pain in posterolateral aspect

55
Q

All actions of subscapularis

A

Medially rotate and depress humerus at GH joint

56
Q

When does shoulder instability occur

A

When head of humerus dislocates from glenoid fossa

57
Q

Shoulder laxity

A

In swimmer and throwing athlete. Loose enough to allow excessive external rotation

58
Q

Shoulder instability

A

Unwanted translation of numeral head on glenoid

Mc moves anterior and inferior

59
Q

Anterior inferior shoulder dislocation

A

MC in younger after indirect trauma with arm abducted, extended and externally rotated

60
Q

Posterior shoulder dislocation

A

Rare

Direct driving force against lower end of humerus with arm flexed forward

61
Q

Clinical findings with posterior shoulder dislocation

A

Decreased fullness of numeral head in anterior and increased in posterior. Swelling masks

Flatter appearance of shoulder and elbow faces out

62
Q

Complications of shoulder instability/dislocation in younger people

A

Ligament or muscle gives away

Often transverse tear across capsule

63
Q

Complications from shoulder instability/dislocation in older people

A

Ligaments become more firm…may cause avulsion fracture because bone less strong

64
Q

Complications to humerus head in shoulder dislocation

A

Compression/impaction fracture of posterolateral aspect of humeral head

Hill-Sachs lesion/hatchet deformity

65
Q

What does glenoid labrum do

A

Increase surface area
Increase depth/concavity
Decrease translation
Key role in GH stability

66
Q

In younger people the tensile strength of the labrum is ____ than the capsule, so ____ prone to injury when _____ stress applied to GH joint

A

Less
More
Anterior

67
Q

Bankart lesion

A

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
Q

SLAP lesion

A

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
Q

What leads to SLAP lesion

A

Deceleration when throwing
FOOSH injury
Sudden traction to biceps

70
Q

Type 1 SLAP lesion

A

Superior labrum markedly frayed but attachments intact

71
Q

Type 2 SLAP lesion

A

Superior labrum has a small tear

Instability of labrum-biceps complex ***

72
Q

What type of SLAP lesion is MC

A

Type 2

Small tear in superior labrum and instability of labradoodles-biceps complex

73
Q

What type of SLAP lesion causes instability of labrum-biceps complex

A

Type 2

74
Q

Type 3 SLAP lesion

A

Bucket-handle tear of labrum that may displace into joint

Labrum biceps attachment intact

75
Q

What type of SLAP lesion causes bucket-handle tear

A

Type 3

76
Q

Type 4 SLAP lesion

A

Bucket-handle tear of labrum that extends into biceps tendon allowing tendon to sublux into joint

77
Q

Superior labrum markedly frayed by attachments intact

A

Type 1 sLAP lesion

78
Q

Superior labrum has a small tear and instability of labral-biceps complex

A

Type 2 slap lesion

79
Q

Bucket-handle tear of labrum that may displace into joint

Labral biceps attachment intact

A

Type 3 slap lesion

80
Q

causes of shoulder instability/dislocation

A

Repetitive strain—looser ligaments due to repetitive overhead motion

  • naturally looser ligaments in all directions
  • trauma
81
Q

Humeral head injury

A

Compression/impaction fraction of posterolateral aspect of humeral head

82
Q

Complications of humeral head injury

A

Hill-Sachs lesion/hatchet deformity

83
Q

Hill-Sachs lesion/hatchet deformity seen when

A

Humeral head injury

84
Q

Bankart lesion seen with which dislocation

A

Anterior GH

85
Q

cause of AC injury

A

Fall or blow to lateral acromion

86
Q

S/s of AC injury

A

Pain in superior/lateral shoulder during cross-arm test (abduct arm across chest)

87
Q

What test can you do you differentiate impingement from AC?

A

Cross arm test.

88
Q

Adhesive capsulitis MC in?

A

Older adults

89
Q

What causes adhesive capsulitis

A

Idiopathic
Minimal trauma
MC in diabetic patients

90
Q

S/s of adhesive capsulitis

A

Achy pain similar to impingement
Decrease in PROM and AROM
Cannot see on X-ray

91
Q

S/s of OA

A

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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