Take the Feburary OCS/SCS Mini-Quiz
QUESITONS:
- A patient has been referred to physical therapy for cervical radiculopathy secondary to spondylosis at C5 and C6. She reports pain, paresthesias and weakness of her arm. She’s had this pain for about 4 months. Which of the following is the least likely alternative diagnosis
A. Parsonage Turner Syndrome
B. Neurogenic Thoracic Outlet Syndrome
C. Venous Thoracic Outlet Syndrome
D. Arterial Thoracic Outlet Syndrome
- All of the following can cause Paget-Schroetter Syndrome except for what?
A. Hypertrophic anterior scalene muscle
B. Hypertrophic subclavius muscle
C. Depression of first rib
D. Cervical first rib
- In regards to Paget-Schroetter Syndrome, which vein is most commonly affected?
A. Subclavian artery
B. Axillary artery
C. Subclavian vein
D. Axillary vein
- What is the gold standard for detecting Paget-Schroetter Syndrome?
A. Wright’s Test
B. Angiogram
C. Venous Duplex Ultrasound
D. Adson’s Test
- What king of malignancy will most likely cause radiculopathy in a C8-T1 nerve root distribution?
A.Tumor affecting the prostate
B. Tumor affecting the thyroid
C. Pancoast tumor affecting the lung
D. Wilm’s tumor affecting the kidney
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ANSWERS:
- A patient has been referred to physical therapy for cervical radiculopathy secondary to spondylosis at C5 and C6. She reports pain, paresthesias and weakness of her arm. She’s had this pain for about 4 months and it has not changed. All of the following diagnoses are can occur except for what?
A. Parsonage Turner Syndrome
Neuritis involving the brachial plexus. Commonly involves the upper trunk of the brachial plexus but has been frequently reported in the literature in other parts of the plexus. It can mimic cervical radiculopathy or a peripheral neuropathy, however, a classic sign of this condition is that pain becomes abolished, but weakness persists.
B. Neurogenic Thoracic Outlet Syndrome
Very common type of thoracic outlet syndrome. Typically will result in weakness and paresthesias down the arm secondary to compression of the neurogenic structures in the interscalene triangle
C. Venous Thoracic Outlet Syndrome
Patient may report discoloration of the arm along with weakness and pain. Typically the venous structures will be compressed in the costoclavicular junction.
D. Arterial Thoracic Outlet Syndrome
This pathology can be caused my occlusion of the subclavian artery secondary to a cervical rib or scalene hypertrophy. The patient may experience pain and paresthesais down into the arm.
Check these articles out:
Monteiro Dos Santos RB, Dos Santos SM, Carneiro Leal FJ, Lins OG, Magalhães C, Mertens Fittipaldi RB. Parsonage-Turner syndrome. Rev Bras Ortop. 2015 Apr 17;50(3):336-41. doi: 10.1016/j.rboe.2015.04.002. eCollection 2015 May-Jun. PubMed PMID: 26229940; PubMed Central PMCID: PMC4519651.
DeLisa LC, Hensley CP, Jackson S. Diagnosis of Paget-Schroetter Syndrome/Primary Effort Thrombosis in a Recreational Weight Lifter. Phys Ther. 2016 Sep 1. [Epub ahead of print] PubMed PMID: 27587803.
- All of the following can cause of Paget-Schroetter Syndrome except for what?
A.Hypertrophic anterior scalene muscle
B. Hypertrophic subclavius muscle
C. Depression of first rib
D. Cervical first rib
Answer choices A, B and C can all cause symptoms suggestive of Paget-Schroetter Syndrome, which can compromise the subclavian vein. Typically a cervical rib will compromise the subclavian artery.
Check this article out:
DeLisa LC, Hensley CP, Jackson S. Diagnosis of Paget-Schroetter Syndrome/Primary Effort Thrombosis in a Recreational Weight Lifter. Phys Ther. 2016 Sep 1. [Epub ahead of print] PubMed PMID: 27587803.
- In regards to Paget-Schroetter Syndrome, which vein is most commonly affected?
A. Subclavian artery
B. Axillary artery
C. Subclavian vein
Paget-Schroetter Syndrome is best described as a primary effort thrombosis that affects the subclavian vein. Most commonly affects weightlifters or upper extremity athletes.
D. Axillary vein
Check out this article:
DeLisa LC, Hensley CP, Jackson S. Diagnosis of Paget-Schroetter Syndrome/Primary Effort Thrombosis in a Recreational Weight Lifter. Phys Ther. 2016 Sep 1. [Epub ahead of print] PubMed PMID: 27587803.
- What is the gold standard for detecting Paget-Schroetter Syndrome?
A. Wright’s Test
B. Angiogram
Angiogram is the gold standard for detecting an effort thrombosis. Answer choice C is a good second choice, and is usually the first test performed for patients with this condition. However, it is not the gold standard. Answer choices A and D are clinical examination techniques that can be utilized, but are not the gold standard.
C. Venous Duplex Ultrasound
D. Adson’s Test
Check this article out:
DeLisa LC, Hensley CP, Jackson S. Diagnosis of Paget-Schroetter Syndrome/Primary Effort Thrombosis in a Recreational Weight Lifter. Phys Ther. 2016 Sep 1. [Epub ahead of print] PubMed PMID: 27587803.
- What king of malignancy will most likely cause radiculopathy in a C8-T1 nerve root distribution?
A. Tumor affecting the prostate
B. Tumor affecting the thyroid
C. Pancoast tumor affecting the lung
Metastases do not commonly occur in the cervical region compared to other areas of the spine. Common tumors that metastasize to the spine are tumors located in the prostate, breast, kidney, thyroid, and lungs. A good way to remember common tumors that metastasize to the spine is to memorize the pneumonic Lead Kettle (PB KTL). Pancoast tumor forms at the superior aspect of the lung and pushes on the C8-T1 nerve roots as it increases in size at the thoracic inlet. This tumor commonly occurs in individuals that are over 50 years old and have a history of smoking. Most will report shoulder pain and rarely have pulmonary symptoms. Often times it is misdiagnosed.
D. Wilm’s tumor affecting the kidney
Check this article out:
Arcasoy SM, Jett JR. Superior pulmonary sulcus tumors and Pancoast’s syndrome. N Engl J Med. 1997 Nov 6;337(19):1370-6. Review. PubMed PMID: 9358132.
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