TOS & FHP - Exam 2

Question 1

what is happening if someone has thoracic outlet syndrome (TOS)?

Answer 1

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

Question 2

what is the root cause of TOS?

Answer 2

limited upper thoracic region due to poor posture (overuse forward head posture)

Question 3

the thoracic sympathetic ganglia near thoracic joints creates what kind of response?
this can then cause what?

Answer 3

deliver fight or flight response
which can cause vasoconstriction with joint dysfunction

Question 4

why are chest breathers more prone to TOS?

Answer 4

they compress the scalenes by excessive use of accessory respiratory muscles.

Question 5

who are most likely to be chest breathers?

Answer 5

smokers –> overuse of accessory muscles

Question 6

what happens if someone with trauma has TOS?

Answer 6

protective muscle gaurding
adhesions and scarring if torn

Question 7

what are some differential diagnoses of TOS? (5)

Answer 7

cervical rib
pancoast tumor compressing medial cord of brachial plexus
carpal tunnel syndrome
spinal nerve impingement
neurovascular diseases

Question 8

what are the 3 things that most often cause TOS?

Answer 8

repetitive stress
poor posture
chest breathing

Question 9

what are symptoms of TOS?

Answer 9

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

Question 10

what things increase TOS symptoms? (3)

Answer 10

raising arms, especially for a prolonged period of time
sleeping
poor sitting posture

Question 11

what would you expect to see in someone with TOS during your observation?

Answer 11

FHP
possible UE discoloration due to degree of a. involvement

Question 12

what would you expect to see in someone with TOS during A/PROM?

Answer 12

possible indications of upper thoracic restriction

Question 13

what would you expect to see in someone with TOS during resisted tests/MMT?

Answer 13

possible decreased strength/endurance in posterior shoulder/scap muscles with FHP
- likely from disuse of those muscles

Question 14

what would you expect to see in someone with TOS during neuro tests?

Answer 14

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

Question 15

why would dermatomes, DTRs and myotomes test WNL for someone with TOS?

Answer 15

it is not a spinal nerve condition

Question 16

what nerve condition is present with TOS?

Answer 16

peripheral nerve

Question 17

what are S&S of dural tension restriction?

Answer 17

paresthesia’s increased from both ends due to decreased elasticity or inflammation

Question 18

how would you treat acute TOS with tension restriction?

Answer 18

treat at rest due to being highly inflamed

POLICED –> do NOT do compression
motion without resistance or symptoms
STM over segmental level

Question 19

how would you treat persistent TOS with tension restriction?

Answer 19

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!

Question 20

what are S&S of dural gliding restriction?

Answer 20

paresthesia’s increased from one end but relieved from the other due to an adhesion

Question 21

how would you treat acute TOS with gliding restriction?

Answer 21

same as neural tension

Question 22

how would you treat persistent TOS with gliding restriction?

Answer 22

same as neural tension but neural mobilizations at MID range

Question 23

when performing neural mobilizations how many movements should you do a day?

Answer 23

10-20 movements a day

Question 24

neural mobilizations have a moderate to large effect on what? (3)

Answer 24

pain
disability
mechanosensitivity

Question 25

what three things predict a good outcome of neural mobilizations?

Answer 25

absence of neuropathy
older age
smaller ROM deficits with median n

Question 26

you perform accessory motion testing for TOS. MORE often what would you be testing for? why?

Answer 26

U upper thoracic hypomobility

limits anterior clavicular rotation with UE elevation
increases tensions on med. cord of brachial plexus

Question 27

you perform accessory motion testing for TOS. LESS often what would you be testing for? why?

Answer 27

limited 1st rib inferior glide

guarded or shortened or scarred scalenes
subluxation with violent contraction during WAD pulls 1st rib superiorly

Question 28

what special test would you use for TOS?

Answer 28

gilliard’s cluster

Question 29

what is the Rx for TOS?

Answer 29

• 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

Question 30

what is happening to the thorax with sitting FHP?

Answer 30

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

Question 31

what is a Dowager’s hump?

Answer 31

fat pad over upper C/T junction that develops with atrophy and shearing

wedging of vertebra due to OA –> often happens in older people

Question 32

FHP leads to:

Answer 32

decreased anti-gravity reflex of muscle
local muscle inhibition
mouth opening

Question 33

what is the most common thoracic restriction (due to FHP)?

Answer 33

bilateral loss of upper thoracic extension
contributes to neck dysfunction and likely lower cervical instability