Symptoms of thoracic outlet syndrome are produced due to compression of______ nerve roots.
Ans. d (C8, Tl) (Bailey And Love 26th/pg. 872).Cervical rib and thoracic outlet syndromeThis rib is usually represented by a fibrous band originating from the seventh cervical vertebra and inserting onto the first thoracic rib. It may be asymptomatic, but because the subclavian artery and brachial plexus course over it, a variety of symptoms may occur. The lower trunk of the plexus (mainly Tl) is compressed, leading to wasting of the interossei and altered sensation in the Tl distribution. Compression of the subclavian artery may result in a post-stenotic dilatation with thrombus and embolus formation.THORACIC OUTLETThe thoracic outlet contains the first rib, the subclavian artery and vein, the brachial plexus, the clavicle, and the lung apex. Injury to these structures may result in postural or movement-induced pain around the shoulder and supraclavicular region. True neurogenic thoracic outlet syndrome (TOS) results from compression of the lower trunk of the brachial plexus or ventral rami of the C8 or T1 nerve roots by an anomalous band of tissue connecting an elongate transverse process at C7 with the first rib. Signs include weakness of intrinsic muscles of the hand and diminished sensation on thepalmar aspect of the fourth and fifth digits. EMG and nerve conduction studies confirm the diagnosis. Treatment consists of surgical resection of the anomalous band. The weakness and wasting of intrinsic hand muscles typically does not improve, but surgery halts the insidious progression of weakness. Arterial TOS results from compression of the subclavian artery by a cervical rib; the compression results in poststenotic dilatation of the artery and thrombus formation. Blood pressure is reduced in the affected limb, and signs of emboli may be present in the hand. Neurologic signs are absent. Ultrasound can confirm the diagnosis noninvasively. Treatment is with thrombolysis or anticoagulation (with or without embolectomy) and surgical excision of the cervical rib compressing the subclavian artery or vein. Disputed TOS includes a large number of patients with chronic arm and shoulder pain of unclear cause.Few important facts about Spine and spinal cord level1. Most commonly reduced disc space in cervical spondylosisC5-C62. The roots most commonly affected in cervical spondylosis & radiculopathy, cervical trauma and spondylolysis (break in pars interarticularis) are:C7 and C63. Symptoms of thoracic outlet syndrome are produced due to compression ofC8-T1 nerve roots4. Most commonly affected in OPLLMid and Lower cervical spine5. Prominent bony tubercle called Chassaignac's tubercle is at the level of cricoid cartilage (a level where trachea ends) and of vertebra0C66. Vertebra prominence (has most prominent and long spinous process among the all-cervical vertebrae, and the tip of which can be felt on palpation just below the nape of the neck)C77. Most commonly missed fracture of cervical spine0Fracture dens/odontoid/peg of C28. IV disc is not present betweenC1-C2 & Sacrum-coccyx9. Supinator jerk, Inverse supinator jerk, Biceps jerk, BrachioradialisC5-C610. TricepsC7-C811. Critical vascular zone of spinal cordT4-T912. Artery of Adamkweicz extends betweenT9-T1113. Subdural space ends atS214. Dura and SA space ends at the level ofLower border of SI15. Spinal cord ends at the level ofLower border of LI in adultsLower border of L3 in children S4 in first 3 mths of intrauterine life16. Site of LP for spinal anaesthesiaL3-L417. Filum terminale and ligamentum denticulatum are derived fromPia mater18. Knee/patellar reflexL3-L419. Ankle jerkS1-S220. Spondylolisthesis is most common atL5-L121. Pott's spine most commonly affectsLower thoracicCERVICAL SPONDYLOSISOsteoarthritis of the cervical spine may produce neck pain that radiates into the back of the head, shoulders, or arms, or may be the source of headaches in the posterior occipital region (supplied by the C2-C4 nerve roots). Osteophytes, disk protrusions, and hypertrophic facet or uncovertebral joints may compress one or several nerve roots at the IV foramina. The roots most commonly affected are C7 and C6. MRI is the study of choice to define the anatomic abnormalities, but plain CT is adequate to assess bony spurs, foraminal narrowing, or OPLL.Spondylolysis is a bony defect in the pars interarticularis (a segment near the junction of the pedicle with the lamina) of the vertebra; the etiology may be a stress fracture in a congenitally abnormal segment. The defect (usually bilateral) is best visualized on oblique view in plain X-rays, CT scan, or SPECT.Spondylolisthesis is the anterior slippage of the vertebral body, pedicles, and superior articular facets, leaving the posterior elements behind. It is more frequent in women. Location: most often L4 on L5 or occasionally L5 on SI. Surgery is considered for symptoms persisting for >1 year that do not respond to conservative measures (e.g., rest, physical therapy), for cases with progressive neurologic deficit, abnormal gait or postural deformity, slippage > 50%, or scoliosis.
C5, C6
C6, C7
C7, C8
C8, T1
Thorax