L19 Thoracic Outlet Syndrome Flashcards
(21 cards)
thoracic outlet syndrome
uncommon cause of UE neuropathy
neuro or vasculogenic compromise from thoracic outlet
diagnosis of exclusion
structures of the thoracic outlet
clavicle
first rib
subclavius
costoclavicular ligament
anterior scalene
neuralvascular structures being compressed
brachial plexus
subclavian vein and artery
types of thoracic outlet
neurogenic form 95%
vascular form 4% venous, 1% arterial
causes of compression in TO
cervical rib
elongated vertebral TP of C7
scalene muscle insertion anomaly
first rib malunion
repetitive shoulder movement
extreme arm positions
abnormal pec minor muscle
weight lifting, rowing, swimming
three areas of compression
scalene triangle
costoclavicular triangle
pec minor space
epidemiology of TO
congenital: cervical rib, prolonged TP, scalene insertion anomaly
acquired: posture, dropped shoulder, heavy breasts, hyperextensioin, WAD, repetitive stress
muscular: hypertrophy scalene, screased trap tones, levator, rhomboids, shortened scalenes, traps, levator, pec
neurogenic TOS
compression in scalene triangle
normal nerve conduction
hx of neck trauma
pain and paresthesia
aggravated by OH shoulder movement
venous TOS
compression of subclavian vein in costoclavicular space
overhead athletes
s/s of heaviness and cyanosis
arterial TOS
compression of subclavian artery from bones
have 5 Ps of ischemia
angiography
hand ischemia, ulcers, pain
exertional arm pain
TOS diagnosis
vague symptoms
shoulder and neck pain radiating into forearm and hand
loss of sensation to little and ring fingers
may be vascular symptoms of ischemia
s/s of neurogenic TOS
pain, paresthesia, numbness, weakness
pain throughout arm, not peripheral or dermatomal
extension to shoulder, neck, back
upper or lower plexus disorders: radial/musculocutaneous nerve vs median/ulnar nerve involvement
pec minor syndrome
compression of neurovascular bundle under pec minor
pain in anterior chest/axilla
few head/neck symptoms
pec minor syndrome treatment
STM
stretch
modalities to increase pec length
scap strength, postural re ed
possible hx of TOS pt
neck trauma
repetitive stress
occipital headaches
pain over traps, neck, shoulder, chest
disability in work and dailt activities
exertional arm pain
has been to other drs before
DD of TOS
C8 radiculopathy
ulnar nerve compression
carpal tunnel
double crush
neck: cervical strain, cervical disc, arthritis, brachial plexus injury
shoulder: RC, fibromyositis
T4 syndrome
special tests TOS
adson’s
wright
roos
imaging findings in TOS
cervical ribs
elongated C7 TP
hypoplastic rib 1
callous formation clavicle/1st rib fracture
pseudoarthritis of 1st rib
soft tissue won’t be able to be seen on imaging
EMG and NCV not helpful except to exclude other conditions
testing for vascular TOS
angiography for arterial
ultrasound, venography for venous
treatment for TOS
avoid exacerbating posture
breathing retraining to avoid accessory muscle usage - diaphragmatic breathing
reduce vigorous aerobic activity using accessory muscle breathing
muscle relaxation
inflammation relief
posture correction
strengthening scapular/thoracic muscles
mobilize shoulder, 1/2nd ribs
post op precautions for TOS decompression
no lifting >5 lbs - 6 wks
no OH activity 2-4 wks
no activities increasing pain or causing new pain
report swelling/signs of infection/worsening N/T/HA/dizziness to surgeon
symptoms after exercise should not last for more than 2 hours
