TOS - Treatment and Condition

Question 1

What is TOS?

Answer 1

Condition that involves the compression of the Neruovascular bundle between the anterior and middle scalenes or between caracoid process and the pec or between the clavicle and the first rib.

Question 2

What are causes for TOS?

Answer 2

Extra cervical rib, Hypertrophy of the Scalenes, bony abnormality of the clavicle and or first rib.
Hypertrophy of the pecs, Trauma to the neck and shoulder.
Poor posture,
Respiratory pathologies.

Question 3

What are symptoms of TOS?

Answer 3

Usually insidious onset,
Numbness, tingling along the C8-T1 dermatomes.
Ache and pain in the shoulder, arm and forearm and hand.
overtime mm weakness develops in the intrinsic mm of the hand.
Weak grip.

Question 4

What symptoms can arise from Venous involvement of TOS?

Answer 4

Pain caused by Ischemia. 
Distal coolness. 
Venous distension. 
Edema. 
Raynaud's Disease. 
Joint stiffness.

Question 5

When Observing a client with TOS, what can be assessed?

Answer 5

Perform a postural assessment:
Minor atrophy of intrinsic hand mms,
Swelling of fingers or dorsum of hand,
Loss of hand coordination.

Question 6

When assessing a client with TOS, what can be palpated?

Answer 6

Mm hypertrophy of sclalene, pecs. 
TP's of involved mms. 
Atrophy of inner hand mms. 
Fascial restrictions. 
Coolness of hands.

Question 7

When assessing a client with TOS, what can you do with special test?

Answer 7

AF / PR ROM of C-spine and shoulder can be used,

Adson’s, Travell’s variation, Eden’s, Write’s hyperabduction, Pec minor length, ULTT’s.

Question 8

What are CI’s for a treating TOS?

Answer 8

Avoid heavy or hot hydrotherapy and scalenes stripping, if the client has high BP.
Avoid frictions if on anti-inflammatory.
Avoid trigger point release, deep work and deep fascial in client on analgesics.
Modify agressive work where mm, skin, circulation is fragile.