Steemit Learning Challenge-S22W6; Thoracic Outlet Syndrome"
Thoracic outlet syndrome is a problem which is affecting nerves as well as blood vessels which are present in neck and shoulder which results in sensation of pain, numbness as well as weakness in arm and hand so it's basically a compression and irritation of nerves and blood vessels at thoracic level (Mainly in thoracic outlet)which is narrow path present in neck and shoulder.
| Types |
|---|
There are three types:-
• Neurogenic TOS which occurs because of compression of nerves.
• Venous TOS which occurs because of compression of veins.
• Arterial TOS which occurs because of compression of artery.
| Stages |
|---|
Thoracic outlet syndrome may progress by going through three stages:-
• There's an acute stage which have sudden onset.
• There's subacute stage which have a gradual onset).
• There's a chronic stage which have long-term effects and develops gradually.
| Symptoms |
|---|
• Patient suffering from thoracic outlet syndrome will suffer from following symptoms:-
• Pain in arms and hand.
• Numbness, tingling in arms and hand.
• Weakness of muscles of arm and hand.
• Swelling of arm and hand.
| Causes |
|---|
• It can be due to any posture abnormality.
• It can be due to any trauma or injury.
• It can be due to a lot of repetitions of motion.
• It can be due to any abnormalities in normal anatomy.
| Treatment |
|---|
• Pain killers and antiinflammatory for pain and swelling management.
• Physical therapy including modalities to subside symptoms and exercises for gradually treating the condition.
• Surgery can be recommended if physical therapy is fail to treat the condition (In severe cases or as last option)
There's a need of following these steps for diagnosis thoracic outlet syndrome condition:-
| History taking, physical examination, clinical evaluation |
|---|
• There's a need of taking history from patient including demographic data and presenting complain of patients and then asking about history of pain that when patient feels symptoms or any occurrence of injuries and also ask about patient occupation.
• There's a need of evaluating patient posture, patient ROM actively and passively, patient muscle strength and patient sensory supply by pinching in arm and hands.Then check for presence of tenderness and swelling in thoracic outlet region and this is all about physical examination and clinical evaluation.
| Special tests |
|---|
• Adson's test:
It's purpose is for evaluating changes in radial pulse with elevating arm.
• In this test doctor will command the patient to extend neck and then rotate it at that side which is affected and then doctor will check radial pulse.
• Wright's test:
It's purpose is for assessing changings in radial pulse while performing abduction of arm.
• In this technique doctor will ask patient to abduct his arm at an angle of 90° and then rote shoulder in downward direction so now doctor will check for radial pulse by palpating.
• Roos test:
It's all about evaluating those symptoms that appears with elevating arm and performance of external rotation.
• In this technique there's a need of elevating patient arm at 90° angle and then there's a need of externally rotating shoulder and asking patient to close and open hand.
It is important to perform each test twice or thrice for much better assessment of radial pulse.
| Imaging studies |
|---|
• X-rays is useful for checking presence of any bony abnormalities.
• MRI is used for evaluation for comprehension or any other abnormality of soft tissue.
• Ultrasound is helpful in assessment of vascular compression or thrombosis.
• EMG is electromyography used for assessment of nerve damage or compression.
| Diagnostic criteria |
|---|
| History taking | 15% |
|---|---|
| Physical examination | 20% |
| Clinical evaluation | 20% |
| Special tests | 25% |
| Imaging studies | 20% |
| Shoulder extension |
|---|
| Shoulder retraction |
|---|
| Shoulder shrugs |
|---|
I performed shoulder extension,shoulder retraction and then shoulder shrugging and I find out most effective exercise at me was shoulder retraction as I was properly feeling contractions at my thoracic level while performing it and I was feeling little difficulty in shoulder extension because of weakness of my extensors and it may be because we don't perform shoulder extension normally during functional activities......
Special invitation to;-
Thank you for understanding the lesson and sharing your assignment; I hope that you will enjoy this week's lesson and try to implement it in your life if you see any such case.
Observations
Task 1 (2.6/3)
You have shared a great knowledge about thoracic outlet syndrome, its symptoms, causes, types but didn't add its other names, separate the vascular and neurogenic symptoms of TOS and arterial & venous is also called vascular, you should add the 3rd type of mix TOS in which vascular & neurogenic both symptoms shown. I appreciate your effort.
Task 2 (2.8/3)
In the second question, you tell us about how you have to assess a patient by doing physical examination, history taking, and investigations. That's good you add special tests and also explanation of special tests. But it would be better to perform them on a patient or healthy individual as I have share the pictures of special tests patient positions in lesson post. Great.
Task 3 (4/4)
You try the shoulder shrugs, external rotation and extension. You did the shoulder shrugs, external rotation and extension correctly. Always remember to apply heat pack in chronic condition and ice pack in acute condition before performing exercises to relax the muscles and reduce stiffness. I appreciate your efforts.
Overall you made a great attempt to answer all the questions. I appreciate your efforts. Keep learning and try to implement your knowledge to the people suffering from thoracic outlet syndrome or any type of spine issue. Thank you.