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TOS Flashcards

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1
Q

what to Thoracic outlet syndrome

A

compression or tension event that compromise the neurovascular structures of the cervicoaxillary canal

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2
Q

cervicoaxillary canal

A

structure where neurovascluar things pass through

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3
Q

cervicoaxillary canal boney

A

scapula
clavicle
5 ribs

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4
Q

cervicoaxillary canal muscle

A

scalenes
pectroalis
minor subclavius

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5
Q

what divides cervicoaxillary canal into upper and lower sections

A

the 1st rib

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6
Q

cervicoaxillary canal (Thoracic outlet) contents

A

brachial plexus and branches
sunclvain vein and art + branches

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7
Q

place of compression - interscalene triangle TOS

A

upper section
ant and post scalene and the 1st rib

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8
Q

place of compression - costoclvicular space

A

upper section
superior scapula , 1st rib, clavicle

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9
Q

place of compression - Thoraco-coraco-pectoral Space
space

A

lower section
pect minor
ribs 2-4
coracoid process

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10
Q

places of compression - regions

A

Thoraco-coraco-pectoral Space
interscalene triangle
costoclavicular space

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11
Q

muscle source of compression

A

subclavius
contributes mostly to VTOS

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12
Q

what is the attachment of the subclavius

A

Costal Cartilage of 1st Rib to Clavicle

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13
Q

what subclavian thing is not normally part of the subclavian triangle

A

subclavian vein

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14
Q

the brachial plexus and the scalenes

A

the brachial plexus normally passes through or pierces the scalenes

pierce the anterior scalene

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15
Q

places of compression all

A

Thoraco-coraco-pectoral Space
interscalene triangle
costoclavicular space
subclavius
cervical rib - Supernumerary Ribs
clavicle
scar tissue

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16
Q

what are Supernumerary Ribs

A

also called accessory ribs are an uncommon variant of extra ribs arising most commonly from the cervical or lumbar vertebrae

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17
Q

type 1 - Supernumerary Ribs

A

Long Rib from C7 with short fibrous attachment to 1st Rib

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18
Q

Type II - Supernumerary Ribs

A

Short Rib from C7 with long fibrous attachment to 1st Rib

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19
Q

what does the clavicle do as you bring up your arm

A

it needs to elavate, retract, and spin

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20
Q

what happens when the clavicle movement is compromised

A

this could compress the tunnel

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21
Q

what could be a cause of clavicle dysfunction

A

AC SC joints

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22
Q

scar tissue and compression

A

Soft Tissue Compression

Enlarged (Scar Tissue) Anterior Scalene, especially after MVA (Demodion et al)

Anomalous Fibrous Bands constricting the tunnel (Roos et al)

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23
Q

type od TOS

Study These Flashcards
A

vascular and neurologic

24
Q

vascular TOS type

Study These Flashcards
A

arterial and venous

25
arterial TOS rate
very rare 1%
26
vascular TOS rate
3-5% seen more in athletes paget-schroetter syndrome
27
neurologic TOS type
true neuro disputed neuro
28
true neuro TOS
confirmed with valid standard diagnostic testing
29
disputed neuro
no confirmation from standard tests
30
what is the TOS movement diagram
flexion pattern with radiating features
31
Double Crush Syndrome
Compression of the axon at one location creates increased susceptibility to effects of compression of the axon at another location (i.e. Carpal Tunnel Syndrome combined with cervical nerve root involvement).
32
Diagnosis of TOS
diagnosis of exclusion
33
where do we mostoften see parathesisa with TOS
UE 98% the arm feel heavy dead an tired
34
what is the common dermtonal distrubtion of TOS
C8 T1
35
location of TOS
UE Paresthesia (98%) Trapezius Pain (92%) Neck Pain (88%) Shoulder/Arm (88%) Supraclavicular Pain (76%) Occipital HA (76%) Chest Pain (72%) Hand Paresthesia (58%)
36
Arterial compression Signs & Symptoms
Secondary to repetitive activities leading to claudication Pain, numbness in non-radicular pattern. Associated fatigue with activity that is relieved at rest Cramping in the hand with use Skin cool to touch; increased sensitivity to cold; Reynaud’s phenomenon Pale discoloration
37
test for ATOS
Allens
38
Venous Compression Signs & Symptoms
Deep pain in chest, shoulder, & entire upper extremity Distal limb edema with paresthesia in hand & fingers; skin tightness; fatigue; cyanosis discoloration Venous distension and heaviness of extremity may be observed after activity – should diminish with rest. If not, then possible venous thrombosis - refer to MD
39
how is VTOS confirmed
Confirmed by special laboratory tests (plethysmography, venography, venous ultrasound studies)
40
TOS neuro sym
Often associated with previous trauma (MVA or Repetitive stress at work) Symptoms include: Pain, paresthesia, numbness, and/or weakness. Cold intolerance (Reynaud phenomenon) due to Sympathetic over activity, not ischemia. Decreased finger dexterity possible.
41
upper plexus NTOS
Upper Plexus Irritation (C5,6,7) – Occipital headache. Pain and paresthesia in anterior chest, periscapular area, radial aspect of arm to dorsum of hand and index finger. Provoked by head movements or lifting.
42
lower plexus irrtation NTOS
Lower Plexus Irritation (C8,T1) – Pain & paresthesia in suprascapular area, posterior neck, medial side of arm & forearm and ulnar digits of the hand. Provoked by activities that depress the shoulders (lifting, carrying a brief case)
43
true neuro tests
* Based on symptoms above & at least 2 (+) provocation tests. EAST test almost always (+). * Confirmed with (+) neurophysiological testing (EMG, NCV)
44
Disputed neuro tests
* Based on symptoms above & at least 2 (+) provocation tests. Cyriax Release test often (+). * No confirmation with objective testing. Negative * Neurophysiological testing; negative vascular tests; negative imaging.
45
what do we see more over true or disputed
disputed * This is what we see most of the time – movement system problem
46
compressors presentation
Symptoms during the day, especially with overhead activities. Increase in tension or compression of the brachial plexus. Usually no night pain unless sleep with arm overhead job - normal have arm over the head Since compression is intermittent, the blood supply returns when arm is lowered & symptoms are relieved
47
what is being compressed with compressors presentation
Compression at costoclavicular &/or pectoralis minor spaces
48
what tests are positive for these pt's -compressor
EAST (Roos) Test is (+) with these patients
49
Release Phenomenon presentation
Brachial plexus under constant tension due to poor posture, weight of the arms during the day In bed, the tension is released; blood flow returns; axonal flow returns; patient feels paresthesia.
50
test for release phenom
(+) Cyriax Release Test
51
what does adons test test
scalene triangle
52
what is a positive adons
reduced pulse or onset of syms
53
costoclvicular - military brace is testing
costo-clvicular space
54
Wright’s (Hyperabduction) testing what space
Retropectoral space (gate). behind the pecct minor
55
Upper Limb Tension (ULTT) is testing what
– Neural irritability from nerve roots to peripheral nerve.
56
what is the most common type of TOS
neuro TOS 95%

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