TOS Flashcards
What is the purpose of Allen’s test?
test the patency of the upper extremity arterial system
occlude each vessel to observe filling time
what does a delayed color return with Allen’s test indicate?
partial blockage- normal return time is 5 seconds
what does no color return with Allen’s test indicate?
complete blockage of the artery or possible occlusion of common vessel
what is the purpose of Adson’s test?
test for neurovascular compression of the subclavian artery and/or brachial plexus
what is a positive Adson’s test?
patient reports paresthesia and or decrease in amplitude of radial pulse
what is a common cause of compression of the neurovascular bundle seen in a + Adson’s test?
hypertrophy of the scalenus anticus muscle and or cervical rib
with a modified Adson’s test, what muscle is being tested?
Scalenus medius muscle or cervical rib
with Halstead’s test, if there is a drop in amplitude of the pulse what does this mean? If there isn’t a drop what do you do next?
a drop in amplitude= + sign
no drop= continue with test and have patient rotate head to the opposite side
what muscle is being tested with Halstead’s test?
scalenus medius and cervical rib
with any TOS test, what should the practitioner always do first?
find the pulse before positioning the patient
with Allen’s maneuver, what is a positive test and what does it indicate?
+ test= disappearance of pulse; indicates TOS
What is the function of Roos’ test?
stress the thoracic outlet area
what is a + Roos’ test?
tingling or paresthesia often in the ulnar side of the forearm and hand; 91% of TOS patients +
what test compresses the axillary artery under the pec minor muscle?
Wright’s test/ hyperabduction test
why must Wright’s test be performed bilaterally?
many patients have cessation of radial pulse upon abduction of the arm so unaffected side needs to be tested for comparison
what is the purpose of the costoclavicular test/ Eden’s test?
narrow space btw clavicle and first rib thus compressing the neurovascular tissues of the subclavian artery, vein and brachial plexus
what are the common causes of narrowed space btw clavicle and first rib?
poor posture
cervical rib
bone tumor
fracture clavicle
what are the indications for a + Eden’s/costoclavicular test?
cessation or dampening of radial pulse
ischemic color changes
paresthesia
radicular pain in upper limb
what are the possible syndromes associated with TOS?
cervical rib
scalene anticus and medius syndrome
costoclavicular syndrome
pectoralis minor
what are the motor signs associated with TOS?
weakness and clumsiness of fingers
grip or pinch strength reduced
reflexes NORMAL
muscle atrophy- MC intrinsic muscles assoc. with C8-T1 nerve roots; less common thenar eminence
what tends to be the first sign of TOS?
paresthesia
What 2 nerves are most commonly affected with TOS?
ulnar and medial cutaneous nerve of forearm; can have paresthesia in all fingers but much less common
In patients with Ulnar Nerve Syndrome, the elbow will never have sensory loss where?
proximal or middle portions of the forearm
Patients with arterial insufficiency in the arm have different sx than those who have neural compression, the early signs include:
coldness
aching muscles
loss of strength after continued use
pale or cyanotic hands
late changes: gangrene of fingertips trophic changes in nails and skin
