Orthopedics Book

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Thoracic Outlet Syndrome

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  1. General
    1. Neural Involvement
      1. Extremity pain
      2. Extremity numbness
    2. Arterial Involvement
      1. Extremity falls asleep
      2. Glove distribution with or without paresis
    3. Venous Involvement
      1. Distal extremity swelling
  2. Causes
    1. Costoclavicular Syndrome
    2. Cervical Rib Syndrome
    3. Hyperabduction Syndrome
    4. Scalenus Anticus Syndrome
  3. Overview Exam:
    1. Adson's Test
    2. Costoclavicular Maneuver
    3. Wright's Test
    4. Sensory and Motor Exam
  4. Management: Conservative (Physical Therapy)
    1. Elevate shoulder
      1. Rest on arm of chair
      2. Sling
    2. Pendulum shoulder Exercises
    3. Moist heat and ultrasound
    4. Strengthening Exercises for shoulder girdle muscles
      1. Trapezius Muscle
        1. Shoulder shrug with weight
      2. Serratus anterior
        1. Bench Press, lifting shoulders from table
    5. Correct faulty posture
    6. Avoid positions that exacerbate symptoms
  5. Management: Surgery
    1. Indications
      1. Vascular compromise (rare)
      2. Conservative management fails after 4-6 months
    2. Surgery (Consider after conservative Rx fails x4-6mo)
      1. Removal of first dorsal and cervical ribs
      2. Release of abnormal scalene muscle insertions
      3. Vascular repair

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