Podcast
Questions and Answers
Which specific muscle is targeted when laterally flexing and extending the head?
Which specific muscle is targeted when laterally flexing and extending the head?
What type of training is recommended for cervical and thoracic extensors?
What type of training is recommended for cervical and thoracic extensors?
Which of the following is NOT listed as a component of conservative management?
Which of the following is NOT listed as a component of conservative management?
What is the purpose of postural education/training in conservative management?
What is the purpose of postural education/training in conservative management?
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Which method is used to stretch the anterior scalene muscles?
Which method is used to stretch the anterior scalene muscles?
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Which structure is located immediately superior to the first rib in the thoracic outlet?
Which structure is located immediately superior to the first rib in the thoracic outlet?
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What is the primary muscle involved in the thoracic outlet region?
What is the primary muscle involved in the thoracic outlet region?
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Which vascular structure is the most anterior in the thoracic outlet region?
Which vascular structure is the most anterior in the thoracic outlet region?
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Which structure passes directly posterior to the clavicle bone in the thoracic outlet?
Which structure passes directly posterior to the clavicle bone in the thoracic outlet?
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Which of the following structures is NOT likely to be compressed in Thoracic Outlet Syndrome?
Which of the following structures is NOT likely to be compressed in Thoracic Outlet Syndrome?
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What anatomical structure is directly involved in thoracic outlet syndrome?
What anatomical structure is directly involved in thoracic outlet syndrome?
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Which muscle is commonly associated with contributing to thoracic outlet syndrome?
Which muscle is commonly associated with contributing to thoracic outlet syndrome?
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Thoracic outlet syndrome involves compression of which of the following structures?
Thoracic outlet syndrome involves compression of which of the following structures?
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Which posture is a contributing factor to thoracic outlet syndrome?
Which posture is a contributing factor to thoracic outlet syndrome?
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What anatomical anomaly is considered a contributing factor to thoracic outlet syndrome?
What anatomical anomaly is considered a contributing factor to thoracic outlet syndrome?
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Which structure is NOT part of the neurovascular bundle compressed in the shoulder?
Which structure is NOT part of the neurovascular bundle compressed in the shoulder?
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Which muscle is involved in the compression of the neurovascular bundle according to the diagram?
Which muscle is involved in the compression of the neurovascular bundle according to the diagram?
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What clinical test is used to assess the presence of neurovascular compression in the shoulder?
What clinical test is used to assess the presence of neurovascular compression in the shoulder?
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Which of the following symptoms is NOT typically associated with neurovascular compression in the affected limb?
Which of the following symptoms is NOT typically associated with neurovascular compression in the affected limb?
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Impaired sensation and motor function due to neurovascular compression in the UE can lead to difficulty with which activity?
Impaired sensation and motor function due to neurovascular compression in the UE can lead to difficulty with which activity?
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Which condition is NOT a cause of spinal canal encroachment?
Which condition is NOT a cause of spinal canal encroachment?
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What is a direct result of the narrowing of the spinal canal?
What is a direct result of the narrowing of the spinal canal?
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Which of the following can occur due to localized trauma?
Which of the following can occur due to localized trauma?
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Where can narrowing of the spinal canal occur?
Where can narrowing of the spinal canal occur?
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Which of the following is an example of pathologic encroachment?
Which of the following is an example of pathologic encroachment?
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What anatomical feature is directly causing the spinal cord compression in cervical stenosis?
What anatomical feature is directly causing the spinal cord compression in cervical stenosis?
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Aside from degenerative discs, what other structure is contributing to spinal cord compression in cervical stenosis?
Aside from degenerative discs, what other structure is contributing to spinal cord compression in cervical stenosis?
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Which part of the spine is specifically affected in cervical stenosis?
Which part of the spine is specifically affected in cervical stenosis?
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In cervical stenosis, what term describes the abnormal bony growths contributing to spinal cord compression?
In cervical stenosis, what term describes the abnormal bony growths contributing to spinal cord compression?
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What might be a consequence if cervical stenosis is left untreated?
What might be a consequence if cervical stenosis is left untreated?
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Which symptom alleviation is commonly reported in patients with spinal cord impairments?
Which symptom alleviation is commonly reported in patients with spinal cord impairments?
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Which condition is NOT a commonly reported impairment in individuals with spinal cord issues?
Which condition is NOT a commonly reported impairment in individuals with spinal cord issues?
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What might patients with spinal cord impairment experience during extension movements?
What might patients with spinal cord impairment experience during extension movements?
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Which of the following is a potential outcome if the spinal cord is affected?
Which of the following is a potential outcome if the spinal cord is affected?
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Which statement accurately describes a possible issue in the presence of spinal cord impairment?
Which statement accurately describes a possible issue in the presence of spinal cord impairment?
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Which structure is specifically altered in both laminectomy and laminoplasty?
Which structure is specifically altered in both laminectomy and laminoplasty?
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What is the primary visual difference in the spine before and after a laminectomy as shown in the illustration?
What is the primary visual difference in the spine before and after a laminectomy as shown in the illustration?
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In the 'After (view from behind)' image, what distinctive feature emphasizes the change post-surgery?
In the 'After (view from behind)' image, what distinctive feature emphasizes the change post-surgery?
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Which direction is the surgical removal or modification conducted during a laminectomy?
Which direction is the surgical removal or modification conducted during a laminectomy?
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Which spinal component remains untouched after the laminectomy procedure shown?
Which spinal component remains untouched after the laminectomy procedure shown?
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Which surgical procedure involves the fusion of two spinal segments?
Which surgical procedure involves the fusion of two spinal segments?
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What is the main purpose of a laminectomy?
What is the main purpose of a laminectomy?
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Which of the following procedures is specifically designed to remove a part of a damaged or herniated disc?
Which of the following procedures is specifically designed to remove a part of a damaged or herniated disc?
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Which surgical procedure primarily aims to relieve pressure on the spinal cord or nerves?
Which surgical procedure primarily aims to relieve pressure on the spinal cord or nerves?
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What distinguishes a spinal fusion procedure from a discectomy?
What distinguishes a spinal fusion procedure from a discectomy?
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Which component of conservative management involves exercises that emphasize spinal bending to reduce symptoms?
Which component of conservative management involves exercises that emphasize spinal bending to reduce symptoms?
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What is a key benefit of postural education/training in conservative management?
What is a key benefit of postural education/training in conservative management?
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Which conservative management technique primarily aims to alleviate symptoms by addressing underlying muscle imbalances and improving movement patterns?
Which conservative management technique primarily aims to alleviate symptoms by addressing underlying muscle imbalances and improving movement patterns?
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What is the main focus of patient education in conservative management?
What is the main focus of patient education in conservative management?
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Which technique is depicted in the bottom image where a person is holding their chin to their chest?
Which technique is depicted in the bottom image where a person is holding their chin to their chest?
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Study Notes
Thoracic Outlet Syndrome
- The thoracic outlet is a region where the subclavian artery, subclavian vein, and brachial plexus pass through.
- Compression of these structures can occur inferior to the clavicle and superior to the 1st rib.
- Contributing factors include:
- Impaired cervical posture (forward head) and thoracic spine posture (kyphosis)
- Tight scalenes
- Shortened pec minor
- Abnormal 1st rib anatomy
Conservative Management
- Stretching focused on the anterior scalene by laterally flexing and extending the head
- Stretching of pectoralis muscles
- Resistance training of cervical and thoracic extensors
- Postural education/training
- Activity/work modifications
Clinical Presentation
- Pain, numbness, tingling, weakness, skin and temperature changes in affected limb (ipsilateral side of neurovascular compression)
- Impaired sensation and motor function of affected UE
- Ex: impaired grasping, difficulty with movements
- PT special tests: Roos, Adson, Upper Limb Tension Tests
Cervical Stenosis
- Narrowing of spinal canal
- Decreased space for spinal cord in canal
- Can occur anywhere in the spinal canal
- Encroachment of spinal canal due to:
- Osteophyte formation
- Loss of disc height and/or disc disease/pathology
- Localized trauma
- Pathologic encroachment (e.g., tumors, cysts)
Clinical Presentation
- Depends on area of spinal cord affected and how much of spinal cord affected
- May complain of pain, impaired motor function, impaired sensation in upper extremity
- Can be asymptomatic and pain not primary complaint
- Forward flexion tends to alleviate symptoms
- Patients will not tolerate extension due to pain
- Limited trunk extension ROM
- If spinal cord affected: difficulty with ADL's, clumsiness of hands/lower limbs, impaired gait and balance
Medical Management
- Surgical procedures:
- Decompressive surgery
- Spinal fusion: two spinal segments fused together
- Laminectomy: removal of lamina
- Discectomy: section of damaged or herniated disc is removed
- Conservative management:
- Pain management
- Patient education
- Postural education/training
- Flexion biased therapeutic exercise
- Stretching
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Description
Identify the labeled structures in the Thoracic Outlet, which can be compressed and contribute to Thoracic Outlet Syndrome. This anatomy quiz covers the Clavicle bone, Subclavian artery, Subclavius muscle, First rib, Subclavian vein, and Brachial plexus.
