TOS & Neuro Tension

Question 1

Thoracic Outlet Syndrome

Answer 1

The compression of the neuromuscular bundle

Question 2

Neurovascular Bundle

Answer 2

Brachial plexus
Subclavian vein
Subclavian artery

Question 3

Brachial Plexus

Answer 3

C5-T1
B/w anterior scalene and middle scalene
Under the clavicle
Over 1st rib
Under the Coro oil process posterior to pec minor

Question 4

Possible causes of TOS

Answer 4

Cervical Rib
↓interscalene triangle (tight scalene)
↓costoclavicular space (costoclavicular syndrome)
↓costocorocoid space (pec minor syndrome)
↓space caused by shoulder droop
Callus formation from clavicles fracture

Question 5

Adson’s Maneuver

Answer 5

Interscalene tightness (ant-middle)

1. Radial pulse
2. EX shoulder and Downward Traction
3. px - Take a DEEP breath in and hold
4. Neck EX and ipsilateral Rotation

Positive

1. Diminished of pulse
2. Reproduction of S/S

Question 6

Travelle’s Variation

Halstead Maneuver

Answer 6

Mid scalene tightness

1. Radial pulse
2. EX shoulder and Downward Traction
3. px - Take a DEEP breath in and hold
4. Neck EX and CONTRALATERALLY Rotation

Positive

1. Diminished of pulse
2. Reproduction of S/S

Question 7

Costoclavecular Syndrome Test

Military Stance

Answer 7

B/W Rib 1 and Clavicle

1. Radial pulse
2. Px - Shoulder Down and Back (Military Stance!!)
3. px - Take a DEEP breath in and hold

Positive

1. Diminished of pulse
2. Reproduction of S/S

Question 8

Wright’s Hyperabduction Test

Answer 8

Pec Minor / Axillary / Costoclavicular?

1. Radial pulse
2. px - Take a DEEP breath in and hold
3. Passively ABduct the arm (no shoulder elevation)
   * hold px’s arm like a guitar

Positive

1. Diminished of pulse
2. Reproduction of S/S

Question 9

Roos Test

Elevated Arm Street Test

Answer 9

TOS, Neuro S/S , Brachial Plexus

1. Px seated or standing
2. No the arms at 90 degree of shoulder AB and ER
3. Px actively bring elbows to 90 degree FL
4. グーパーグーパー 3 minutes

Positive

1. Inability to maintain upper limb position
2. Ischemic pain
3. Numbness and parasthesia

Question 10

Allen’s test

Answer 10

TOS, Brachial Plexus (mid scalene)

1. Px shoulder AB 90 degree with elbow FL 90 degree
2. Radial pulse
3. Px CONTRALATERALLY Rotaion

Positive
Radial pulse weakens or disappears

Question 11

Upper Limb Neural Tension Maneuvers

Median Nerve / ULNT1

Answer 11

1. Px Supine
2. Shoulder girdle Depression & slightly AB shoulder
3. Elbow EX with slight ER of shoulder
4. Supination of forearm
5. Wrist, finger and thumb ET
6. Full AB

Question 12

ULNT 2

Median, Musculocutaneous, Axillary Nerve

Answer 12

1. Supine
2. Shoulder girdle Depression and slight AB
3. Elbow EX with FULL ER of shoulder
4. Supination of the forearm
5. Wrist, finger and thumb EX
6. Full AB

Question 13

ULNT 3

Radial Nerve

Answer 13

1. Supine
2. Shoulder girdle Depression and slight AB
3. Elbow EX with IR of shoulder
4. Pronation of the forearm
5. Wrist, finger and thumb FL with wrist Ulber deviation
6. CONTRALATERALLY Lateral FL of c-spine

Question 14

ULNT 4

Ulnar Nerve

Answer 14

1. Supine
2. Wrist EX and Forearm Supination
3. Elbow FL
4. Shoulder girdle Depression
5. = above position and add ER and AB
6. Contralaterally Lateral FL c-spine

Question 15

LLNT Maneuver

Sciatic Nerve

Answer 15

1. Supine
2. SLR position
3. Elbow EX with FULL ER of shoulder
4. Ankle Dorsiflexion
5. Hip AD
6. Hip IR
7. Cervical FL

• Eversion to Dorsiflexion - more tension to Tibial Tract
• Inversion to Dorsiflexion - Surat Tract
• Plantarflextion with Inversion - Common Peroneal Tract

Question 16

LLNT

Femoral Nerve

Answer 16

1. Px Prone
2. Knee FL
3. Hip EX

Question 17

Interscalene Tightness

Answer 17

1. Adson’s maneuver

2. Travell’s Variation/ Halstead maneuver

Question 18

B/W Rib 1 and Clavicle

Answer 18

Costoclavicular Syndrome

Military Stance

Question 19

Pec Minor syndrome / Axillary?

Answer 19

Wright’s Hyperabduction test

Question 20

TOS / Neural tension s/s / Brachial plexus

Answer 20

1. Roos Test / Elevated arm stress test

2. Allen’s Test for the shoulder