Download PRE COURSE READING Thoracic Outlet Syndrome

PRE COURSE READING
Thoracic Outlet Syndrome
1. Making use of the internet or other sources that may be available to you, investigate and bring to the training day
two home exercises advocated for patients in the treatment of Thoracic Outlet Syndrome. Make a note of what you
believe to be the clinical reasoning underpinning the use of these two exercises.
2. Add to the diagram of the brachial plexus on the next page, the nerve root components of each peripheral nerve as
given in the table below. Please trace down the plexus to gain an idea as to how these numbers are arrived at. The
suprascapular nerve has been done for you e.g. C5,6. (Please note that the diagram does not show the fascicular
pathways for each nerve root)
3. Please revise the brachial plexus picture and memorise the names of each peripheral nerve and its nerve root
origins.
Name of nerve
Nerve root (s)
Suprascapular Nerve
C5,6
Nerve to subclavius
C5
Lateral Pectoral Nerve
C5,6,7
Musculocutaneous Nerve
C5,6,7
Upper Subscapular Nerve
C5,6
Thoracodorsal Nerve
C6,7,8
Lower Subscapular Nerve
C5,6
Axillary Nerve
C5,6
Radial Nerve
C5,6,7,8
Median Nerve
C5,6,7,8,T1
Medial Pectoral Nerve
C8,T1
Medial Brachial Cutaneous Nerve
C8,T1
Medial Antebrachial Cutaneous Nerve
C8,T1
Ulnar Nerve
C8,T1
Long Thoracic Nerve
C5,6,7
Dorsal Scapular Nerve
C5
Lateral Pectoral
Suprascapular
Dorsal scapular
C5,C6
Musculocutaneous
Nerve to Subclavius
Axillary
Median
Radial
Lowr Subscap
Uppr Subscap
Thoracodorsal
Med. Ante-Brachial Cut
Ulnar
Medial Pectoral
Medial Brachial Cut
Long Thoracic
© T.Bayford 2009
Please revise the following facts prior to attendance of Thoracic Outlet
Syndrome course.
Anatomy review:Please revise these basic facts
Ribs
1. A typical rib consists of a head, neck, tubercle and shaft.
2. The head of a typical rib articulates with the vertebral body. The lower portion
of the head forms a synovial joint with the vertebral body of its corresponding
number and the upper part forms a synovial joint with the vertebral body above.
3. The tubercle of the rib articulates with the articular facet of the transverse
process of its corresponding number
4. The first rib is atypical and it only articulates with T1 vertebral body.
5. The first rib has a short broad shaft. Its superior surface has a tubercle for the
attachment of anterior scalene. In front of this tubercle is a groove for the
passage of the subclavian vein and behind the tubercle lies a groove for the
passage of the subclavian artery and inferior trunk of the brachial plexus
Thoracic Vertebrae
1. The spinous process of the vertebrae is approximately adjacent to the
transverse process of vertebrae below
Muscles supplied by the median and ulnar nerves
Muscles supplied by the Median Nerve
Muscles supplied by the Ulnar nerve
Pronator Teres
Flexor Carpi radialis
Palmaris longus
Flexor digitorum superficialis
Flexor digitorum profundus I and II
(Anterior interosseous)
Flexor pollicis longus
(Anterior interosseous)
Pronator Quadratus
(Anterior interosseous)
Abductor pollicis brevis
Opponens pollicis brevis
Flexor pollicis brevis
Lumbricals I and II
Flexor carpi ulnaris
Flexor digitorum profundus III and IV
Palmaris brevis
Abductor digiti minimi
Opponens digiti minimi
Flexor digiti minimi
Palmar interossei PAD
Dorsal interossei DAB
Lumbricals III and IV
Adductor pollicis
Flexor pollicis brevis (deep head)
Anatomy of the Cubital Tunnel
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The tendinous arcade between the humeral and ulnar attachments of Flexor
Carpi Ulnaris and the underlying bones and ligaments forms an osseo-fibrous
foramen often called the cubital tunnel
The cubital tunnel houses the ulnar nerve.
Anatomy of Guyons canal
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The curved convex ulnar surface of the hook of hamate forms the lateral wall.
The roof is composed of the thin volar ligament and fibres of the palmaris
brevis.
The floor is composed of the flexor retinaculum and piso-hamate ligament.
This canal houses the ulnar artery and ulnar nerve distal to the wrist creases