Flashcards in 18_ Sternum, Clavicle, Sibson's Fascia Deck (18):
Boundaries of the superior thoracic aperture.
medial: rib cage and 1st rib medially
What is thoracic outlet syndrome?
compression of the passing neurovascular bundle
What is the thoracic inlet?
esophagus, and trachea. Allows for passage of things that are not in circulation.
What would be clinical signs of the thoracic outlet syndrome?
1. numbness/tingling, blue discoloration, edema, pulselessness, palor.
What can lead to thoracic outlet syndrome?
cervical ribs, repetitive motions, and acute trauma.
What are the three points of compression for the thoracic outlet syndrome (TOS)?
sites of compression are the brachial plexus, subclavian aa, subclavian vv.
What are the boundaries for thoracic inlet?
Lateral: 1st ribs bilaterally.
Clinically what is considered the thoracic inlet?
manubrium to the angle of Louis, ribs 1 and 2, and TV1-TV4
What structures are contained in thoracic inlet?
1. recurrent laryngeal
2. vagus nn
3. phrenic nn
4. brachial plexus
5. common carotid aa.
6. vertebral aa.
7. thyrocervical trunk
8. internal thoracic aa
9. internal jugular vv.
10. subclavian aa/vv
12. anterior cervical nodes
13. thoracic duct and R lymphatic duct
Describe the course of Sibson's fascia.
1. Between TP of CV7 and medial aspect of first rib. Is continuous with deep cervical fascia.
2. Covers the cupula of lungs and inner lining of scalene muscles.
3. acts as cervicothoracic diaphragm
What is the function of Sibson's Fascia?
acts as cervicothoracic diaphragm.
What is the method for Sibson's fascia MFR?
1. steering wheel technique.
2. Place fingers over clavicles with palm on trapezius and thumbs on TP of TV1.
3. palpate fascia in 3 directions, wait for release and reassess.
What are the anatomical landmarks for the following:
- suprasternal notch
- sternal angle
- xiphoid process
- supresternal notch= TV2
- sternal angle = TV4
- xiphoid process= TV9
- umbilicus = LV3-4
What is MET for superior clavicular head?
1. Monitor the SC joint.
2. Extend and internally rotate shoulder to feather edge.
3. Have pt push shoulder into flexion, with Dr resisting
What is the MET for anterior clavicular head?
1. Monitor the SC joint.
2. use the other hand to grip the medial border of scapula.
3. Pt drapes hand over neck.
4. Straighten back to lift pt's scapula to feather edge. encourages clavicular head to move posterior.
5. pt pulls shoulder to table and resist
How do you diagnose clavicle rotation?
1. monitor distal clavicle motion with one hand, and use passive motion of the humerus.
2. posterior rotation induced by humerus flexion
3. anterior rotation induced by humerus extension
How do you treat an anteriorly rotate clavicle (would have resistance to posterior motion)
1. proximal fingers over clavicle.
2. distal hand grabs proximal forearm
3. move arm into flexion (post rotation of clavicle)
4. distal hand abducts humerus with slight compressive force medially.
5. move arm through arc into extension.