Physio Edge podcast

December 2019
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Mon, 16 December 2019

096. Thoracic outlet syndrome with Jo Gibson

Patients with thoracic outlet syndrome (TOS) may have undiagnosed pain and symptoms into their shoulder, arm, hand, scapula, head, face, upper back, axilla, chest and anterior clavicle.

With a number of potential sources of pain in these areas, TOS patients commonly have a delayed or incorrect diagnosis, followed by unnecessary and unsuccessful surgery. Further complicating matters, imaging and nerve conduction studies are often clear or inconclusive. Studies show that on average, patients with TOS have an average of 5 years of symptoms and see 6 doctors before receiving an accurate diagnosis.

What tests and questionnaires will help guide your diagnosis and intervention? When are patients suitable for Physiotherapy and conservative management? When should you refer on for a surgical opinion?

In this podcast with Jo Gibson (Clinical Physiotherapy Specialist), you will discover:

What is Thoracic outlet syndrome (TOS)?
Commonly reported symptoms of TOS
Three different types of TOS
The most common type of TOS with around 80% of all TOS patients
Why imaging and investigations are often clear, and don’t match up with symptoms
3 key causes of TOS
The relationship between TOS and hypermobility syndrome
Criteria for diagnosis in the latest TOS diagnostic consensus statement
Differential diagnosis (DDx) - Cervical NR compression, and peripheral nerve entrapment
Common subjective findings that guide you towards a diagnosis of TOS
A questionnaire you can use to assist cervicobrachial diagnosis
What information is gained from imaging, including MRI and MR Neurography & nerve conduction studies
What are the limitations of imaging?
What is the difference between small nerve fibre and large nerve fibres, and how this impacts diagnosis
QST - Quantitative sensory testing - Pin prick (Neurotip) and Thermal testing - warm and cold
Simple QST test using a coin
Objective testing
- What tests do you need to perform in patients with suspected TOS?
- What is the elevated stress test (EST)?
- What information does an upper limb tension test (ULTT) provide?
- Does a negative ULTT test exclude TOS?
How are nerve blocks used?
What is the best way to perform a nerve block?
How effective are nerve blocks in assisting diagnosis?
Who should we refer on for early medical or surgical management?
When should you get an early surgical opinion?
Which patients are likely to benefit from conservative management?

Podcast handout

Free video series “Frozen shoulder assessment & treatment” with Jo Gibson

Shoulder: Steps to Success online course with Jo Gibson

Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Links associated with this episode:

Articles associated with this episode:

Direct download: Physio_Edge_096_Thoracic_outlet_syndrome_with_Jo_Gibson.mp3
Category:general -- posted at: 11:34am AEDT

Thu, 5 December 2019

095. Sternoclavicular joint pain diagnosis, imaging & red flags with Jo Gibson

The sternoclavicular joint (SCJ) can cause pain locally, or refer into the neck and shoulder. With a relatively high incidence of serious and potentially life-threatening pathology at the SCJ, it’s important to diagnose the source of SCJ pain. In this (Facebook live/video/podcast) with Jo Gibson (Clinical Specialist Physiotherapist), you’ll discover:

How to identify and diagnose the SCJ as the source of pain.
Where does the SCJ commonly refer pain to?
What pathologies cause SCJ pain
What activities & movements commonly reproduce pain in the SCJ?
Who develops SCJ pain?
Which differential diagnosis (DDx) are important to identify, including
- localised osteoarthritis (OA)
- rheumatoid arthritis
- septic arthritis
- atraumatic subluxation
- seronegative spondyloarthropathies
- gout, pseudogout
- SC hyperostosis
- condensing osteitis
- Friedrich’s disease/avascular necrosis
- condensing arthritis
- Friedrich’s disease and
- ‘SAPHO’ (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome
How does DDx impact prognosis?
What role does imaging have with the SCJ?
SCJ Imaging - MRI vs CT vs Xray.
If pain refers down to the anterior chest, what other structures may be involved?
Tietze syndrome at the costochondral junction.
Costochondritis - who develops it, is there a mechanism of injury?
Red flags you need to be aware of around the SCJ
Case study of an SCJ patient where a potentially life-threatening illness was identified.
Other red flags - infection, HIV, septic arthritis, diabetes, ankylosing spondylitis, gout.
What investigations are important for SCJ pain patients?
What are realistic expectations for prognosis and resolution of SCJ symptoms?
How can you rehab patients with SCJ pain?
Costochondral joint pain.
Rehab following clavicular ORIF
When is arthroscopic release suitable in frozen shoulder patients

Podcast handout

Free video series “Frozen shoulder assessment & treatment” with Jo Gibson

Shoulder: Steps to Success online course with Jo Gibson

Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Links associated with this episode:

Direct download: Physio_Edge_095_Sternoclavicular_joint_pain_diagnosis_imaging__red_flags_with_Jo_Gibson.mp3
Category:general -- posted at: 4:50pm AEDT