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Thoracic Outlet Syndrome
Musculo Exam 2 TOS
41
Anatomy
Graduate
03/20/2012

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Cards

Term
define thoracic outlet syndrome
Definition
symptom complex characterized by pain, parasthesia, weakness, and discomfort in arm aggravated by elevation of the arms or exaggerated head and neck movements
Term
at what age is TOS most common
Definition
20-50
Term
do TOS cases usually have neurological involvement
Definition
yes
Term
do TOS cases usually have vascular involvement
Definition
no, 4-6%
Term
what is neurogenic TOS
Definition
brachial plexus injury documented by nerve conduction or EMG
Term
what is vascular TOS
Definition
subclavian artery/vein dysfunction documented by imaging
Term
what is nonspecific or disputed TOS
Definition
patients have symptoms, but no tests document a lesion. Very common
Term
3 sites of TOS compression
Definition
scalene triangle, costoclavicular space, coracopectoral space
Term
borders of the scalene triangle
Definition
anterior scalene, middle scalene, first rib
Term
what are the contents of the scalene triangle
Definition
trunks of brachial plexus, subclavian artery
Term
what are the borders of the costoclavicular space
Definition
clavicle, 1st rib
Term
what are the contents of the costoclavicular space
Definition
trunks of brachial plexus, subclavian artery and vein
Term
what can cause TOS
Definition
tight scalenes or elevated 1st rib
Term
how to determine TOS
Definition
palpate 1st rib and look for elevation
Term
borders of coracopectoral space
Definition
coracoid process, pec minor, ribs 2-4
Term
contents of coracopectoral space
Definition
cords of brachial plexus, axillary artery and vein
Term
causes of TOS
Definition
congenital abnormality, trauma, functionally acquired
Term
what are congenital abnormalities that cause TOS
Definition
cervical rib (long TP at C7), fibrous/muscular anomaly such as nerves going through scalene
Term
what traumas can cause TOS
Definition
fractured clavicle, whiplash
Term
what things cause functionally acquired TOS
Definition
hypertrophic muscles from ADLs, training, breathing and bad posture
Term
how will posture change with TOS
Definition
shoulder protraction shortens SCM, scalenes, pec minor
Term
are TOS vascular symptoms common
Definition
no, 4-6%
Term
what are venous TOS symptoms
Definition
swelling, cyanosis
Term
what are arterial TOS symptoms
Definition
ischemia with effort, Raynaud's, cold limb
Term
are neurological TOS problems easily reproduced with nerve testing
Definition
no
Term
what are neurologic symptoms of TOS
Definition
thenar, hypothenar, interosseous weakness and atrophy; ulnar and medial antebrachial cutaneous numbness; paraesthesia and weakness that is undefined; fatigue in UE; aggs = raise arms, heavy load
Term
what to ask in TOS history
Definition
Onset of symptoms (when, how, where); History of trauma/stress; occupation with overhead; aggs/eases; PMHx
Term
how is TOS a diagnosis of exclusion
Definition
not very common, so check it out when you can't figure out what's wrong
Term
what's the exam sequence for TOS
Definition
UQ screen, assess shoulder, special tests
Term
what TOS test is for scalene involvement
Definition
Adson's
Term
what TOS test is for clavicular involvement
Definition
costoclavicular test
Term
what TOS tests are for pec minor
Definition
hyperabduction/Wright's test; Allen's test
Term
what TOS test is for general TOS
Definition
Roo's
Term
what else can be used for TOS testing
Definition
upper limb tension testin
Term
how to treat TOS
Definition
ergonomics, behavioral changes. Address posture
Term
how to address posture in TOS
Definition
posterior muscle lengthening. Anterior/superior muscle shortening. Downward rotation of scapula
Term
how long will it take to see improvements from exercise in TOS
Definition
2 weeks
Term
what specific postural exercises are good for TOS
Definition
scapular pinches, shoulder circles, chin tuck, slump sit to upright sit
Term
what to stretch in TOS treatment
Definition
scalenes, pec minor, upper traps
Term
what to strengthen in TOS treatment
Definition
middle/lower traps, serratus, LB extensors, triceps, lats
Term
what to mobilize in TOS treatmetn
Definition
cavicle, C-spine, 1st rib, scapula
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