Thoracic outlet syndrome
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This document defines and describes thoracic outlet syndrome, which is a neurovascular disorder caused by compression of the brachial plexus and subclavian artery/vein in the thoracic outlet. It most commonly affects young adult females and can be caused by anatomical variations like a cervical rib or abnormalities of the scalene muscles. Symptoms include pain, numbness, and weakness in the arm. Diagnosis involves tests like MRI and nerve conduction studies. Treatment is initially non-surgical but may involve surgical removal of a cervical rib or scalene muscles in severe cases.
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The document discusses the anatomy and biomechanics of the shoulder joint and various types of shoulder dislocations. It describes the glenohumeral joint as a ball and socket joint between the humeral head and glenoid cavity. It then covers the different ligaments and muscles that support the shoulder joint. The rest of the document discusses the mechanisms, clinical presentations, investigations, and treatments for the main types of shoulder dislocations including anterior, posterior, inferior dislocations. It also notes potential complications of shoulder dislocations.
Thoracic outlet syndrome
Thoracic outlet syndrome is caused by compression of the neurovascular structures in the thoracic outlet. It can be neurogenic, venous, or arterial in type. Key findings on examination include a positive Adson's test or Roos test. Imaging such as MRI, CT, and angiography can help in diagnosis. Treatment involves conservative measures initially followed by surgical decompression if symptoms persist, with procedures such as scalenectomy and first rib resection.
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Thoracic Outlet Syndrome and Physiotherapy Management
Thoracic Outlet Syndrome and Physiotherapy Management, definition, anatomy, Classification, etiology, Clinical feature, Diagnostic Test, Special test( Roos Test/ Elevated arms stress test, Adson maneuver, Wright’s Test Or maneuver, Shoulder Girdle Passive Elevation/ Cyriax Release, Costoclavicular syndrome test/ Military brace Test, Provocative Elevation test, Halsted maneuver, ULTT), Investigation, Physiotherapy, management, Exercise, Serratus anterior,
Thoracic outlet syndrome
thoracic outlet syndrome; one of the disorder affecting shoulder joint and neck movements due to limitation and pain. this slideshow describes about; the definition, types, causes and physiotherapy management for the same.
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Thoracic outlet syndrome
- 2. Definition: It is a neuro-vascular disorder due to compression of the trunks of the brachial plexus and subclavian artery and vein at the thoracic outlet.
- 6. Incidence: It is more common in adolescents and young adult females. Cervical rib is bilateral in 50%-75% of cases.
- 7. Aetiology: I- Causes: 1- Cervical rib syndrome: An extra rib that originates from the transverse process of the 7th cervical vertebra. It may be: a) - Complete: attached to manubrium or 1st rib. b) - Incomplete: with tapering end that is usually connected by a fibrous band to scalene tubercle of the 1st rib. c) - Incomplete: with a bulky bony end.
- 8. 2- Scalene syndrome: a) - Tight scalene muscles. b) - Abnormal attachment of scalene muscles that leave small space between them. 3- Costoclavicular syndrome: the brachial plexus , the subclavian artery and vein are compressed in the narrow space between the clavicle and the 1st rib.
- 9. 4- Hyper abduction syndrome: the brachial plexus , the subclavian artery and vein are stretched around the coracoids process and pectoralis minor during elevation of the arm. II- Predisposing factors: neuro-vascular compression in thoracic outlet syndrome is precipitated by Lifting of heavy weight on the shoulder. .
- 10. Pathology: Site: more on the right side (dominant hand). Pathological changes: compression of the trunks of the brachial plexus and subclavian artery occurs as they pass through the triangle formed by scalenus anterior anteriorly, scalenus medius posteriorly, and the 1st rib inferiorly. The subclavian vein passes in front of the scalenus anterior outside the triangle and escapes compression.
- 11. Clinical picture: Symptoms: Neurological manifestations:(more common) due to compression on C8-T1 roots. a)- Sensory: shooting pain along the medial side of the forearm with numbness and tingling over the ulnar side of the hand. b) - Motor: weakness and atrophy of the small muscles of the hand.
- 12. c) - Autonomic: stimulation of sympathetic fibres in T1 may cause Raynaud’s phenomenon. 2- Vascular manifestations: Intermittent claudication pain in the upper limb which appears with exercise.
- 13. Signs: 1-Unequal radial pulse. 2- Palpable cervical rib. 3- Adson’s test: while the upper limb is hanged down palpate the radial pulse then ask the patient to turn his head to the opposite side. In positive cases, the pulse will disappear or become weaker.
- 14. EAST—Elevated Arm Stress Test (Modifi ed Roos test): Arm is elevated above the shoulder, with elbow stretched fully. Rapid movements of fingers will cause fatigue on the side where cervical rib is present. Costoclavicular compression manoeuvre: While palpating the radial pulse of the patient he is asked to move his shoulder backwards and downwards (exaggerated military position) which may cause absence/feeble radial pulse and a bruit may be heard while auscultating the supraclavicular region
- 15. Complications: Neurological complications: sensory, motor and autonomic effects. Chronic ischemia: due to compression of the subclavian artery. Poststenotic aneurysm: due to maldirected flow of blood causing aneurysmal dilatation that may harbor a thrombus with possible embolism
- 16. Investigations: 1- X-ray: may reveal an extra rib.
- 17. 2- MRI: may reveal fibrous band. 3- Nerve conduction velocity study.
- 18. 2- Surgical: Is used as a last step in sever cases. a) - if there is cervical rib: Excision of the cervical rib with its periosteum. b) - if there is no cervical rib: 1- Scalenectomy. 2- Transaxillary resection of the 1st rib.
- 19. Thank You