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part 4 Flashcards

1
Q

What are the different parts of the subclavian artery

A

Part 1- different left compared to right
a.right comes off the brachiocephalic trunk behind the SC joint > ascends superior and lateral to anterior scalene
b.left comes aortic arch behind the common carotid > passes superior border of the anterior scalene
Part 2- passes posterio to the anterior scalene
Part 3- passes up and over 1st rib into the supraclavicular triangle > turns into axillary artery

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2
Q

What structure separates the subclavian artery and vein?

A

anterior scalene

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3
Q

What are the four anatomical spaces relevant to the thoracic outlet?

A
  1. sternocostovertebral
  2. scalene triangle
  3. costocalvicular space
  4. pectoralis minor space
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4
Q

What are the borders of the sternocostovertebral space?

A
  1. Sternum anteriorly
  2. spine posteriorly
  3. first rib laterally
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5
Q

What is found in the sternocostovertebral space?

A
  1. subclavian vein
  2. subclavian artery
  3. brachial plexus
  4. apex of the lung
  5. pleura
  6. sympathethetic trunk
  7. jugular vein
  8. lymphatics of the neck
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6
Q

What are the borders of the scalene triangle?

A

Anterior scalene
middle scalene
first rib

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7
Q

What are the borders of the costoclavicular space?

A
  1. one third of the clavicle and subclavius anteriorly
  2. first rib and sclene insertion medially
  3. superior border of the scapula posteriorly
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8
Q

What is found in the costoclavicular space?

A
  1. costoclavicular ligament
  2. subclavian vien
  3. subclavian artery
  4. brachial plexus
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9
Q

What are the borders of the pectoralis minor space and what is found in the space?

A
  1. ribs
  2. pectoralis minor
  3. brachial plexus and axillary vessels
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10
Q

Are cervical rib a pathological condition?

A

No, only 1.2% of patient with upper extremity symptomology are found to have cervical ribs

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11
Q

How many types of congenital fibromuscular band are been identified in the thoracic outlet?

A

1- anterior tip of incomplete cervical rib to posterior scalene tubercle
2- tip of enlarger C8 TP to posterior scalane tubercle
3- muscular band from body of T1 TP across the space to the first rib
4- connection between anterior and middle scalene
5- scalenes minimus from TP of lower cervical spine to attachbtween Middle and anterior scalene
6- scalene minimus that attaches to the pleura
7- passess beneth the subclavian vein

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12
Q

What are some examples of congenital anomolies that influence the thoracic outlet?

A
  1. fibrous bands
  2. hypoplastic first rib
  3. exostosis of the first rib or clavicle
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13
Q

Describe the myofacial layer that cover the region of the thoracic outlet

A
  1. Deep cervical fascial wraps arond the posterior belly of the omohyoid
  2. it travels down and splits to envelope the subclavius
  3. it then joints the clavicopecotoral fascia with a thickening of the costocoracoid membrane
  4. splits again to enclose pectoralis minor
  5. it terminates at suspensory ligament of the axilla
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14
Q

What is the true tissue in lesion the anterior scalene TOS

A

1.C3 innervates anterior scalene
increases tone in anterior scalene and effect TOS
2.C3 innervates diaphragm
3.dysfunction of the diaphragm leads to upper respiratory breathing

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15
Q

What is costocalvicular syndrome?

A

the vascular structures are compressed by clavicle on the first rib with retracted and depressed scapula

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16
Q

Why is there some controversy over costoclavicular syndrome?

A

some studies have demonstrated that as the clavicle is depressed it actually moves forward and increases the space between the first rib and clavicle

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17
Q

How can you test for costoclavicular syndrome?

A
  1. exagerated military posture
  2. deep inspiration
  3. monitor pulse
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18
Q

What is hyper abduction syndrome?

A
  1. At 180 degree of elevation the neurvscular bundle is bent at a 90 degree angle around the coracoid process
  2. contraction of the pec minor or subscapularis will compress the neurovascular bundle
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19
Q

What are some possible causes of the pec minor space compression?

A
  1. postural kyphosis
  2. overuse of accessory respiratory muscles
  3. direct trauma to muscle or rib
  4. upper thoracic spine dysfunction
  5. costal or intercostal leasion
  6. facilitated segment of the CT juntion
20
Q

How might the GH joint contribute to TOS issues?

A

compression follow anterior subluxation due to failure of the GH ligaments or coraco-clavicular ligaments

21
Q

How would differentiate TOS from other pathology?

A
  1. Signs of peripheral neuritis due to intermittent interruption of blood flow
  2. There is the potential for an effect on the pulse
  3. there is a non segmental pain referral pattern
22
Q

What role do the C5, 6, 7 segments have on sympathetic distribution?

A
  1. C5 and 6 transmit sympathetic fibers to the brachial plexus
  2. C7 transmits fibers to the brachial plexus, subcalvian vessel and phrenic nerve
23
Q

How would you test for anterior scalene involvement of TOS?

A
  1. Allen (contralteral rotation) and Adson’s (ipsalateral rotation) test
  2. Rotate the head
  3. slightly extend the neck
  4. monitor pulse
  5. take a big breath in
24
Q

Why is monitoring the pulse during TOS testing subject to debate?

A
  1. Roo himself pointed out the compression of the vasculature has “little to do with cause of symptoms in about 99% of the cases”
  2. studies confirm that testing proceedures cause vascular changes in healthy populations also
25
What is Chamberlain’s Line?
line between the posterior margin of the hard palate and the posterior margin of the foramen magnum
26
What is Fielding’s sign?
Lateral view, distance between anterior arch of C1 and odontoid process, normally less than 3 mm, 3-5 mm rupture of transverse lig, 10-12 rupture of all ligaments
27
What is Fishgold Line?
line between mastoid processes
28
What is McGregor's line?
Hard plate to most caudal point of the occiput
29
What is McRae's line
line across the foramen magnum
30
What is steel's rule of thirds?
Inner space of C1 is about 3 cm and is equally occupied by dens, spinal cord, and free space
31
How does the projection angle effect an x-ray?
As the beam fans out it creates some distortion; therefore, in the lower segments of the spine you will have what appear to be narrowing of the disc space.
32
What are radiopaque objects?
objects that block x-rays
33
What is a Jefferson fracture?
1. burst fracture of C1 typically into four parts 2. may result from compression second vertebrae or hyperextension 3. pain in the upper neck with limited neuro signs, but may effect vascularture causing symptoms of harmner’s syndrome, temp sensation, medullary syndrome, ataxia
34
How are odontoid fractures classified?
type I: fracture through the tip requiring fusion type II: fracture through the base requiring fusion type III: fracture through the body of C2 usually stable and require immobilization
35
What is the key characteristic of an x-ray of a dens fracture?
the Dens should be centered between that lateral masses
36
What is Ponticulus Ponticus?
1. small boney bridge from the posterior arch of C1 that encircles the vertebral artery 2. it may or may not form an accessory foramina 3. incidence is anywhere from 5-37%
37
What makes dosing and treating the cervical spine more complicated?
your have a unique interaction of the sympathetic nervous system, vestibular system, ocular reflexes, closed head injuries and the effects of upper cervical instability
38
How do you avoid exacerbation of neurologic overlaying when dosing exercises for the cervical spine?
Go back to the basic set of 10 no matter what functional quality you are dosing for
39
What is the standard order of movement direction with selective tissue training?
1. all pain free motions 2. movement in painful plane away from pain 3. movement in painful plane towards but not into pain
40
The trigeminal nucleus receives nociceptive input from what nerves?
1. trigeminal 2. facial 3. glossopharyngeal 4. vagus 5. C1-C3
41
How do you test upper cervical motion?
1. mechanically lock the lower cervical spine using flexion and extension and the principles of protraction (OA ext with lower cervical flexion) and retraction (OA flex with lower cervical extension) 2. OA side bending flexion and extension quadrant using protraction and retraction 3. OA side bend neutral with lower cervical full rotation 4. AA rotation with ligamentous locking by flexing the spine 5. AA rotation with couple motion locking by lateral flexion and AA rotation away
42
Give some examples of lower cervical locking for upper cervical isolation exercises?
1. side bending of the lower cervical spine will lock the cervical spine using couple motions so that you can isolate upper cervical rotation in the opposite direction 2. flexion of the lower cervical spine can ligamentously lock the lower cervical spine for isolated upper cervical extension or rotation 3. Rotation of the cervical spine can lock the lower cervical spine for isolated upper cervical flexion and extension training 4. extension of the lower cervical spine can ligamentously lock for isolated upper cervical flexion
43
What muscles are primarily tonic and phasic in the cervical spine?
1. tonics: multifidi, suboccipitals, deep neck flexors (longus colli primary), rotatory muscles 2. phasics: splenius capitis, semispinalis capities and cervicis
44
How does the theory of co-contractions change in the cervical spine?
1. typically as the load increases both that primary mover and secondary musculature have to increased in activation 2. in the cervical spine just the prime move will increase in activation
45
Why is it inappropriate to focus on a single muscle as the cause of pain or weakness?
1. the brain recruits muscles in synergies 2. instead exercises should focus on normalizing tissue tolerances to resolve noxious input to correct recruitment patterns

cervical (6 decks)

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