TOS - PowerPoint PPT Presentation

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TOS

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Thoracic outlet syndrome (TOS) is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene. – PowerPoint PPT presentation

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Title: TOS


1
THORACIC OUTLET SYNDROME
  • Dr. Deborah Denno
  • NMS 670

2
THORACIC OUTLET SYNDROME
  • AKA Neurovascular Compression Syndromes
  • Classic Presentation Diffuse arm symptoms,
    numbness, tingling typically down medial arm to
    4th and 5th digits.
  • Symptoms are worse with overhead activity.

3
THORACIC OUTLET SYNDROME
  • Generalized Symptoms Pain in the upper
    extremity, paraesthesia, numbness, weakness, skin
    discolorations, swelling, Raynauds Phenomenon.

4
Anatomy of TOS
  • The Neurovascular Bundle (NVB)
  • Brachial Plexus
  • Subclavian Artery/Vein
  • Axillary Artery/Vein

5
Causes of TOS
  • Elongated C7 TVP
  • Cervical Rib (or fibrous band)
  • Trauma, exostosis
  • Posture induced (Forward head/rounded shoulders)
  • Pancoast Tumor
  • Scalene Muscles (spastic, flaccid, or anomalous)
  • Costoclavicular area
  • Subcoracoid area (Pec minor/Coracoid Pr.)

6
Cervical Ribs
  • A congenital overdevelopment, bony or fibrous, of
    the C7 costal process. Can be unilateral or
    bilateral
  • Usually asymptomatic.
  • Occurs in 1 of the population and only 10 of
    those are symptomatic.
  • Pain and paresthesias in the medial forearm and
    hand, usually relieved by changing position. Can
    have weakness and difficulty with fine motor
    control.

7
Interscalene Triangle
  • Anterior Scalene
  • Middle Scalene
  • T1 Rib
  • Subclavian Artery
  • Brachial Plexus
  • Subclavian Vein passes anterior

8
Interscalene Triangle
9
Scalenus Anticus Syndrome
  • Scalene muscles elevate the 1st Rib, lateral
    flexion and rotation. Also flexion.
  • C8/T1 are at greatest risk.
  • Symptoms pain, paresthesia, hyperesthesia and
    numbness. These can occur anywhere from the
    shoulder to the fingers.
  • Ischemia numbness, cold, weakness, and skin
    color changes.
  • Adsons Test is diagnostic

10
Costoclavicular Syndrome
  • NVB is compressed between the 1st Rib, Subclavius
    muscle and Clavicle.
  • The Subclavian Vein is most susceptible.
  • Sense of Fullness in the Hand and Fingers
  • Cramping pain in the forearm and hand
  • Vague shoulder pain
  • Swollen and engorged veins-intermittent
  • Symptoms dont follow dermatome or NR.
  • Shoulder ROM is maintained.
  • Costoclavicular Maneuver and Edens Test are
    diagnostic.

11
Hyperabduction Syndrome
  • Occurs with repetitive or prolonged
    hyperabduction of the arm.
  • Involves the BP and Axillary Art/Vein
  • Compressed by tendon during Abduction.
  • Pain, paresthesia, and numbness occur first in
    the fingers, later in the hand.
  • May resemble Raynauds Ds.
  • Neurologic symptoms are usually absent.
  • Wrights Test is diagnostic

12
General Rules
  • Symptoms depends on
  • Frequency
  • Duration
  • Degree of Compression
  • Perform Allens Test first to determine the
    patency of the Radial and Ulnar Arteries.

13
Treatment of TOS
  • Postural Correction
  • Stretching tight muscles
  • Strengthening weakened muscles
  • Trigger Point Therapy
  • Adjust the 1st Rib
  • Adjust clavicle, shoulder, C and T spines

14
Special Studies
  • X-ray for fracture/dislocation, cervical ribs
  • Arteriography for patency of vessels.

15
Differential Diagnosis
  • Central Lesions? Spinal Cord Tumors
  • Plexus Lesions? Pancoast tumor
  • Peripheral Nerve Lesions
  • Carpal Tunnel Syndrome
  • Cardiac Symptoms
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