Thoracic Outlet Syndrome Overview

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Questions and Answers

What anatomical feature is most commonly associated with true neurological deficits in thoracic outlet syndrome?

Cervical ribs

Costoclavicular space

Fibromuscular bands (correct)

Subcoracoid tunnel

What is the primary consequence of shortened sternocleidomastoid muscles?

Increased diaphragm efficiency

Improper head and neck alignment (correct)

Improvement in shoulder mechanics

Enhanced scalenes function

Which type of thoracic outlet syndrome affects the vascular structures?

Disputed Thoracic Outlet Syndrome (dTOS)

Vascular Thoracic Outlet Syndrome (vTOS) (correct)

Neurological Thoracic Outlet Syndrome (nTOS)

True Neurological Thoracic Outlet Syndrome (tTOS)

Which anatomical condition is least likely to cause thoracic outlet syndrome?

Congenital blindness Signup and view all the answers

How do tight scalene muscles affect rib movement?

They pull the first rib cranially. Signup and view all the answers

What happens when the pectoralis minor muscle is tight?

It causes the scapula to tilt forward and rotate downward. Signup and view all the answers

Which of the following is a common feature presented by individuals with thoracic outlet syndrome?

Protracted scapula Signup and view all the answers

In the context of thoracic outlet syndrome, what percentage of cases are classified as neurological?

97% Signup and view all the answers

Which muscles are responsible for providing upward rotational force to the scapula?

Serratus Anterior and Lower Trapezius Signup and view all the answers

Which condition can result from weak hip extensors such as the glutes and hamstrings?

Anterior pelvic tilt Signup and view all the answers

What factor is commonly associated with increased tension in the neurovascular bundle in thoracic outlet syndrome?

Anteriorly shifted shoulders Signup and view all the answers

What issue can arise from abnormal muscle mechanics at the pelvis?

Increased stress on other body segments Signup and view all the answers

Which factor is considered a more common cause of thoracic outlet syndrome than rib anomalies?

Poor posture Signup and view all the answers

What role do the scalenes play during breathing?

They are accessory muscles of respiration. Signup and view all the answers

Which condition directly indicates the presence of true neurological deficits?

True Neurological TOS (tTOS) Signup and view all the answers

How can the presence of a supernumerary cervical rib affect the body?

By compressing the brachial plexus Signup and view all the answers

What condition can result from weak abdominal muscles, leading to lumbar vertebrae lordosis?

Thoracic vertebrae kyphosis Signup and view all the answers

Which type of trauma can contribute to the development of thoracic outlet syndrome (TOS)?

Microtrauma from repetitive overhead activity Signup and view all the answers

In diagnosing thoracic outlet syndrome, what is crucial for accurate identification?

Differentiation between neurogenic and vascular compression Signup and view all the answers

Which evaluation methods are commonly used to assist in the diagnosis of suspected TOS?

Nerve conduction studies and electromyography Signup and view all the answers

What common symptom may indicate thoracic outlet syndrome, particularly related to vascular compression?

Decreased hand grip strength Signup and view all the answers

Which option best describes a characteristic of thoracic outlet syndrome?

Symptoms may not appear immediately after trauma Signup and view all the answers

Which structure's injury could correlate with the development of thoracic outlet syndrome following trauma?

Scalene muscle Signup and view all the answers

Which imaging technique is utilized in the diagnosis of vascular thoracic outlet syndrome?

Venography Signup and view all the answers

Which muscle group is typically adaptively shortened in individuals with thoracic outlet syndrome?

Anterior and middle scalenes Signup and view all the answers

What does a hard end-feel during the cervical rotation-side bending test indicate?

Hypomobility of the first rib on the opposite side Signup and view all the answers

Which symptom is commonly associated with neurogenic thoracic outlet syndrome?

Numbness or tingling in the arm or fingers Signup and view all the answers

What enhances symptoms of thoracic outlet syndrome when the upper extremities are involved?

Arm abduction overhead with axial rotation Signup and view all the answers

Which assessment is performed to evaluate first rib position and mobility?

Cervical rotation-side bending test Signup and view all the answers

Which nerve roots are primarily involved in upper plexus compression during thoracic outlet syndrome?

C5, C6, C7 Signup and view all the answers

Which of the following anatomical structures should be assessed for malalignment in the case of thoracic outlet syndrome?

First rib Signup and view all the answers

What is a common consequence of scalene muscle hypertonicity in patients with thoracic outlet syndrome?

Rib elevation Signup and view all the answers

What is the primary goal of the Cyriax release technique in managing thoracic outlet syndrome (TOS)?

To unload the neurovascular structures in the thoracic outlet Signup and view all the answers

Which sleeping position is recommended for TOS patients to promote better sleep quality?

Sleeping on the uninvolved side Signup and view all the answers

What type of surgery may be effective in treating thoracic outlet syndrome when all structures are released?

Transaxillary resection of the first rib Signup and view all the answers

Which supportive item can help alleviate pressure on neurovascular structures for larger-chested women with TOS?

Supportive bra with wide and posterior-crossing straps Signup and view all the answers

What is a common consequence of disturbed sleep patterns in patients suffering from thoracic outlet syndrome?

Symptoms of the ‘release phenomenon’ Signup and view all the answers

What type of exercises are typically introduced in postoperative physical therapy for TOS patients?

Shoulder and cervical range of motion exercises Signup and view all the answers

Which technique can be employed to assist TOS patients in achieving a correct sleep posture?

Pinning pajama sleeves to pajama legs Signup and view all the answers

What activity should patients avoid for 2-4 weeks post-surgery for thoracic outlet syndrome?

Overhead activities and lifting Signup and view all the answers

Study Notes

Thoracic Outlet Syndrome (TOS)

TOS is a condition where the nerves and/or blood vessels in the space between your collarbone and your first rib (thoracic outlet) are compressed.
It affects 95-98% of brachial plexus and 2-5% of vascular structures.
TOS usually affects females more than males, and most cases are related to anatomical factors, such as a narrower thoracic outlet.
Females have naturally less-developed muscles, a greater tendency for drooping shoulders, and a lower sternum, all of which contribute to higher prevalence of TOS.
There are three common sites of compression in TOS: interscapular triangle, costoclavicular space, and sub-coracoid tunnel.
The compression may be vascular, affecting the subclavian artery and vein, or neurological, affecting the brachial plexus.
Neurological TOS can be further categorized into True Neurological TOS (tTOS) with true neurological deficits and Disputed / non-specific / Symptomatic TOS (sTOS) with only subjective symptoms.
TOS can be caused by anatomical defects, such as cervical ribs, which are present in 0.5-0.6% of the population, with a female-to-male ratio of 2:1.
Cervical ribs and fibrous bands are the most common causes of neurological compression, with women more affected than men.
Poor posture, especially flexed head position, depressed shoulder, and protracted scapula, can lead to TOS.
Tight and shortened muscles, like scalenes and pectoralis minor, can contribute to TOS by decreasing costoclavicular space.
Weakness in scapular muscles like serratus anterior and lower trapezius can lead to scapula tipping forward and rotating downward, contributing to TOS.
Pelvic alignment can affect posture, leading to abnormal stresses on the body and potentially contributing to TOS.
Trauma from car accidents (whiplash) or muscle strain from repetitive overhead activities can cause TOS.
Repetitive activities like typing, overhead lifting, and sports like baseball pitching and swimming can also contribute to TOS.
Diagnosis of TOS relies on history, physical examination, provocative tests, and potentially ultrasound, radiological, and electrodiagnostic evaluation.
TOS may need to be differentiated from other conditions with similar presentations, such as cervical radiculopathies and upper extremity entrapment neuropathies.
Electrodiagnostic evaluation, including nerve conduction studies and electromyography, helps diagnose TOS by showing decreased ulnar sensorial potentials and decreased median action potentials.
Vascular TOS can be identified with venography and arteriography.
Imaging studies, like cervical spine and chest x-rays, help identify bony abnormalities such as cervical ribs and "peaked C7 transverse processes".
Physical examination includes: Assessment of respiratory pattern, assessment of thoracic outlet closers muscles, assessment of first rib position and mobility, assessment of clavicle position, assessment of scapula position, assessment of scapular muscle strength, and assessment of acromioclavicular and sternoclavicular joint mobility.
Symptoms of TOS can include pain in the neck, face, occipital region, chest, shoulder, and upper extremity.
Symptoms are often worse with activities like abduction and external rotation of the arm, with head rotated to the same or opposite side.
Neurogenic TOS symptoms include numbness/tingling in the arms or fingers, pain in the neck, shoulder, arm, or hand, arm fatigue with activity, and weakening grip.
When the upper plexus is involved, pain can radiate to the ear and face.
Possible treatments for TOS include breathing exercises, supportive taping, neural mobilization, patient education, activity modification, postural re-education, and surgery.
Disturbed sleep patterns can be a common symptom of TOS and can be addressed with sleep position modifications: avoid sleeping on the affected side and stomach, use pillows for support, and utilize Cyriax release technique before sleeping.
Surgery options for TOS include supraclavicular scalectomy and transaxillary resection of the first rib, aimed at releasing compressed structures.
Postoperative physical therapy focuses on: shoulder and cervical range of motion exercises, gentle neural mobilization techniques, and avoidance of overhead activities and lifting for 2-4 weeks.
Some women with TOS may benefit from a supportive bra with wide and posterior-crossing straps to reduce tension on neurovascular structures.
In extreme cases, breast-reduction surgery may be considered to alleviate TOS and biomechanical problems.
TOS is a complex condition with various causes and presentations, requiring a multidisciplinary approach for effective diagnosis and management.

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Description

This quiz covers key aspects of Thoracic Outlet Syndrome (TOS), including its definition, affected populations, anatomical factors, and common sites of compression. Explore the differences between neurological and vascular TOS and understand the underlying causes of this condition.