TOS & FHP - Exam 2 Flashcards
what is happening if someone has thoracic outlet syndrome (TOS)?
compression of subclavian artery and possible brachial plexus (peripheral n.)
compression from the top down or bottom up - basically any compression in this “A frame” area
what is the root cause of TOS?
limited upper thoracic region due to poor posture (overuse forward head posture)
the thoracic sympathetic ganglia near thoracic joints creates what kind of response?
this can then cause what?
deliver fight or flight response
which can cause vasoconstriction with joint dysfunction
why are chest breathers more prone to TOS?
they compress the scalenes by excessive use of accessory respiratory muscles.
who are most likely to be chest breathers?
smokers –> overuse of accessory muscles
what happens if someone with trauma has TOS?
protective muscle gaurding
adhesions and scarring if torn
what are some differential diagnoses of TOS? (5)
cervical rib
pancoast tumor compressing medial cord of brachial plexus
carpal tunnel syndrome
spinal nerve impingement
neurovascular diseases
what are the 3 things that most often cause TOS?
repetitive stress
poor posture
chest breathing
what are symptoms of TOS?
UE glove/sleeve like paresthesias
– non segmental paresthesia means cutaneous nerve –> intermittent and short duration. fast progression because there is minimal overlap of peripheral nerves
coldness and swelling with vascular compromise
what things increase TOS symptoms? (3)
raising arms, especially for a prolonged period of time
sleeping
poor sitting posture
what would you expect to see in someone with TOS during your observation?
FHP
possible UE discoloration due to degree of a. involvement
what would you expect to see in someone with TOS during A/PROM?
possible indications of upper thoracic restriction
what would you expect to see in someone with TOS during resisted tests/MMT?
possible decreased strength/endurance in posterior shoulder/scap muscles with FHP
- likely from disuse of those muscles
what would you expect to see in someone with TOS during neuro tests?
non-segmental hypoactivity
-dermatomes (-): decreased sensation along peripheral n. distribution
-myotomes (-): possible weakness of muscle innervated by peripheral n.
-dural mobility tests (+): because of inflamed nerves
why would dermatomes, DTRs and myotomes test WNL for someone with TOS?
it is not a spinal nerve condition
what nerve condition is present with TOS?
peripheral nerve
what are S&S of dural tension restriction?
paresthesia’s increased from both ends due to decreased elasticity or inflammation
how would you treat acute TOS with tension restriction?
treat at rest due to being highly inflamed
POLICED –> do NOT do compression
motion without resistance or symptoms
STM over segmental level
how would you treat persistent TOS with tension restriction?
treat at resistance
motion with resistance (exercises, AROM)
neural mobilizations with resistance at END range once acuity settles
– provoke and relieve but never hold or move with symptoms!
what are S&S of dural gliding restriction?
paresthesia’s increased from one end but relieved from the other due to an adhesion
how would you treat acute TOS with gliding restriction?
same as neural tension
how would you treat persistent TOS with gliding restriction?
same as neural tension but neural mobilizations at MID range
when performing neural mobilizations how many movements should you do a day?
10-20 movements a day
neural mobilizations have a moderate to large effect on what? (3)
pain
disability
mechanosensitivity
what three things predict a good outcome of neural mobilizations?
absence of neuropathy
older age
smaller ROM deficits with median n
you perform accessory motion testing for TOS. MORE often what would you be testing for? why?
U upper thoracic hypomobility
limits anterior clavicular rotation with UE elevation
increases tensions on med. cord of brachial plexus
you perform accessory motion testing for TOS. LESS often what would you be testing for? why?
limited 1st rib inferior glide
guarded or shortened or scarred scalenes
subluxation with violent contraction during WAD pulls 1st rib superiorly
what special test would you use for TOS?
gilliard’s cluster
what is the Rx for TOS?
- posture/ergonomic - education and scap taping
- diaphragmatic breathing to minimize accessory respiratory muscles
- MT/MET in cervico-thoracic regions to improve mobility
- MET to increase strength and endurance in scap/shoulder muscles
what is happening to the thorax with sitting FHP?
flexed, compressed, depressed
diaphragm overworked
thoracic extensors and accessory muscles overwork to help with respiration
thoracic stiffness develops, may lead to instability at lower cervical region
what is a Dowager’s hump?
fat pad over upper C/T junction that develops with atrophy and shearing
wedging of vertebra due to OA –> often happens in older people
FHP leads to:
decreased anti-gravity reflex of muscle
local muscle inhibition
mouth opening
what is the most common thoracic restriction (due to FHP)?
bilateral loss of upper thoracic extension
contributes to neck dysfunction and likely lower cervical instability
