Thoracic Outlet sydrome

Question 1

EMG/NCS will be negative for what 3 things?

Answer 1

radiculopathy, carpal tunnel syndrome, nerve injury

Question 2

two etiologies of TOS:

Answer 2

osseous v. soft tissue –> w/in those, vascular v. neurogenic

Question 3

osseous related-TOS after trauma to what area?

Answer 3

Trauma to H/N. 60-70% have injury to neck or shoulder girdle.

Question 4

scalene and/or pectoral mm restriction, C-spine hyperF/E, apical tumor of lung - all etiologies of what?

Answer 4

soft tissue TOS

Question 5

changes in shoulder position alters what space in pre-existing postural/structural changes?

Answer 5

alters costoclavicular space

Question 6

progressive decompensation in homeostatic mechanisms in soft tissue etiologies of TOS can be aggravated by ___ or ___

Answer 6

aggravated by stress or trauma

Question 7

Short leg syndrome is an example of what etiology of TOS?

Answer 7

soft tissue postural in the coronal plane, asymmetrical tension in muscles and fascia.

Question 8

increased anterior tilt (hyperlordosis-lumbar) creates ___ compensatory change in the sagittal plane that could result in soft tissue postural etiology of TOS?

Answer 8

increased anterior tilt = protraction of shoulder = postural change

Question 9

increased anterior tilt (hypolordosis-lumbar) creates ___ compensatory change in the sagittal plane that could result in soft tissue postural etiology of TOS?

Answer 9

increased posterior tilt = protraction of shoulder girdle = postural change

Question 10

All of the following are etiologies of what? Prominent C7 transverse process, cervical ribs, 1st rib abnormalities, fx of 1st rib with callus formaiton, calvicular fx.

Answer 10

osseous etiology of TOS

Question 11

Provocative test for scalenes

Answer 11

adson’s maneuver

monitor radial pulse for diminishment with abd and looking TO same side=rib; AWAY=scalene spasm

Question 12

Provocative test for pec minor

Answer 12

wright’s hyperabduction or EAST

Question 13

Provocative test to determine if there is any pressure between clavicle and ribs

Answer 13

costoclavicular maneuver (monitor radial pulse in E and abd)

Question 14

If you suspect apical lung tumor OR cervical rib, ___ diagnostic imaging ordered

Answer 14

CXR

Question 15

If you suspect radicular findings or hard neurologic evidence, order ____.

Answer 15

MRI

Question 16

2-4 weeks before pathology shows on ___ test

Answer 16

EMG (plexopathy (TOS))

Question 17

***four nerve conduction tests suggestive of TOS

Answer 17

• Low amplitude ulnar sensory responses.
• Low amplitude ulnar motor responses.
• Low amplitude median motor response.
• Normal median sensory conduction.

Question 18

Five pharmacologic tx of TOS.

Answer 18

• analgesics
• NSAIDs, Steroids
• Muscle relaxants
• amitriptyline (25mg/day)
• gabaepentin (900-2400mg/day)

Question 19

Physical therapy modalities

Answer 19

• moist head
• Ultra Sound
• Electrical stimulation
• postural stretching/strengthening of scalenes, rhomboids, trap, levator scapulae

Question 20

avoid shoulder abduction >__ degrees in mm strengthening exercises. why?

Answer 20

45 degrees bc reactivated trigger point in parascapular muscles

Question 21

MFR to what two muscles?

Answer 21

scalene (seated, supine)

pec (supine, side lying)

Question 22

surgical tx for TOS - what is transaxillary v. scalenectomy

Answer 22

• transaxillary approach - removal of rib 1

- scalenectomy - supraclavicular decompression - cervical rib, anterior/middle scalene removal

Question 23

Self stretching for what two mm

Answer 23

scalene and pectoral muscles

Question 24

directions for self stretch

Answer 24

hold 30 sec, 10 stretches, BID

Question 25

make sure they know that self stretching scalene and pectoral muscle will _____sx

Answer 25

EXACERBATE the sx, but pain/deep ache should not persist after stretch released.

Question 26

What is muscle engram and what happens in TOS?

Answer 26

It is the muscle length that the muscle spindle and CNS recognize. This is shortened in TOS.

Question 27

How do you lengthen engram in TOS?

Answer 27

Myofascial structures stretch by plastic deformation - with recoil after stretch. The frequency of stretch is important, allows gradual change to engram.