Thoracic Outlet Syndrome Flashcards
1
Q
Trunks of the Brachial Plexus
A
- Upper: C5 and C6
- Middle: C7
- Lower: C8 and T1
2
Q
Cords of the Brachial Plexus
A
- Posterior: C5, C6, C7, C8, T1
- Lateral: C5, C6, C7
- Medial: C8 and T1
3
Q
Impingement prior to peripheral nerve branches in the cervical spine foramina degeneration
A
- roots are not mixed until they exit the foramina
- dorsal root is in close proximity to facet joint
- ventral root is in close proximity to uncovertsebral joint
4
Q
Key symptoms of cervical spine impingement foramina degeneration
A
- dermatomal pattern
- can just be sensory without motor component
- reproduced with closure of foramina
5
Q
Impingement of cervical spine at disc
A
- bulge/prolapse tend to cause mechanical inflammation & chemical inflammation (acute) to occupy significant space
6
Q
Key symptoms of cervical spine impingement at disc
A
- dermatomal pattern usually limited to 1
- usually a pattern across neurological tests (sensory, motor, & reflexes)
- foramina closure can reproduce symptoms but repetitive opening may increase symptoms
7
Q
Thoracic outlet syndrome
A
- entities within the supraclavicular area that can contribute to the symptoms of neuromuscular compression
8
Q
Etiology, Anatomy, & Symptomology of thoracic outlet syndrome
A
- anatomical structures compressing the brachial plexus
- thoracic outlet: brachial plexus, anterior & medial scalene, clavicle
- nerve root irritation & damage = referred pain
9
Q
Anatomical spaces in the thoracic outlet
A
- sternocostovertebral space
- scalene triangle
- costoclavicular space
- pectoralis minor space
10
Q
Describe the sternocostovertebral space
A
- roots have just left the spine & trunks have not formed
- Pancoast tumor
11
Q
Describe impingement at the scalenes
A
- usually roots pass all the way through scalenes but trunks may start to form on distal edge
- C5, C6 sit close together because they are upper trunk
- C7 sits alone regardless
- C8 tends to join T1 outside anterior scalene to form lower trunk
12
Q
Key symptoms of impingement in the scalenes
A
- thoracic outlet tests (Adson’s sign)
- if just neurogenic thoracic outlet syndrome (95%): sensory is positive along dermatomal pattern
- typically it is C5, C6 that are impinged unless you have a large rudimentary cervical rib attached to C7 (C8)
13
Q
Describe Adson’s test
A
- find the patient’s radial pulse in neutral then extend the arm while feeling the radial pulse
- patient can look towards or look away from extended arm
- positive = lose of pulse
14
Q
Erb’s Palsy
A
- severe C5 and C6
- tearing of the brachial plexus during childbirth
15
Q
Key symptoms of costoclavicular syndrome
A
- posterior, lateral, & medial cord sensory and motor patterns
- special tests: costoclavicular maneuver (60s, lift arm above head & hyperabduct horizontally for Sx), Roos (60s-3min, open & close hands with hands above head)
