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Thoracic Outlet Syndrome Medical Treatment Guidelines

General Guidelines Principles

1. An education-based paradigm should always start with inexpensive communication providing reassuring and evidence-based information to the patient.

A. True B. False

2. No treatment plan is complete without addressing issues of individual and/or group patient education as a means of facilitating self-management of symptoms and prevention.

A. True B. False

3. Goals of active therapeutic exercise programs should incorporate:

A. Patient flexibility B. Patient coordination C. Patient education D. All of the above

4. Which of the following is considered an objective functional gain?

A. Range of motion B. Activities of daily living C. Efficiency/velocity measures that can be quantified D. All of the above

5. If a given treatment or modality is not producing positive results within two to three weeks, the treatment should be either modified or discontinued.

A. True B. False

Initial Diagnostic Procedures

6. Neck pain is often the first symptom with complaints within the first few days of injury.

A. True B. False

7. All of the following may contribute to thoracic outlet syndrome, except for:

A. Clavicular fractures, cervical strain, and other causes of cervical trauma injuries. B. Occasional overhead lifting C. Activities which cause overdeveloped scalene muscles. D. All of the above may contribute to TOS.

8. Which of the following is not one of the Upper Limb Tension Test steps?

A. Arm is extended 90 degrees with elbow straight out. B. Wrist is palmar-flexed. C. Head is tilted to opposite side, putting ear to shoulder. D. All of the above are steps for the Upper Limb Tension Test.

Therapeutic Procedures - Non-Operative

9. Formal psychological or psychosocial evaluation should be performed on patients not making expected progress within 6 to 12 weeks following injury and whose subjective symptoms do not correlate with objective signs and tests.

A. True B. False

10. When could acupuncture be used?

A. When pain medication is reduced or not tolerated. B. As an adjunct to physical rehabilitation and surgical intervention. C. As part of multidisciplinary treatment to hasten the return of functional activity. D. Any of the above.

11. Inpatient pain rehabilitation programs may be necessary for:

A. Patients with moderate-to-severe impairment of physical / functional status. B. Patients with moderate-to-severe pain behaviors. C. Patients with a dependence on medications from which he/she needs to be withdrawn. D. All of the above.

12. With regard to therapeutic exercise programs, which of the following is NOT true?

A. A therapeutic exercise program should be initiated at the start of any treatment rehabilitation. B. Such programs should emphasize education, independence, and the importance of an on-going exercise regimen. C. Particular exercise regimen are recommended. D. Exercise alone or part of a multidisciplinary program resulted in decreased disability for workers at least with non-acute low back pain.

13. The occupational medicine rehabilitation interdisciplinary team should, at a minimum, be comprised of all of the following, except for:

A. Certified biofeedback therapist B. Occupational therapist C. Physical therapist D. Medical director

14. The use of a patient completed pain drawing, visual analog scale, is highly recommended to help track progress.

A. True B. False

15. At the time of this guideline writing, which of the following have been FDA approved for treatment of diabetic neuropathic pain and chronic musculoskeletal pain?

A. Venlafaxine B. Milnacipran C. Duloxetine D. All of the above

16. During patient education, it is recommended that specific individual goals are articulated at the beginning of treatment as this is likely to lead to increased patient satisfaction above that achieved from improvement in pain or other physical function.

A. True B. False

17. Prolonged immobility results in which of the following deleterious effects?

A. Loss of muscle strength and flexibility. B. Promotion of bone demineralization. C. Impaired disc nutrition. D. All of the above.

18. All of the following muscles should be targeted for correct timing and recruitment during neuromuscular re-education, except for:

A. Posterior deltoid B. Serratus anterior C. Upper trapezius D. Lower trapezius

Therapeutic Procedures - Operative

19. Post-operative therapy will frequently require a repeat of the therapy provided pre-operatively.

A. True B. False


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