INTERESTING TIMES

Thoracic Outlet Syndrome Tests have poor validity, as there is a false positive rate of 53-92%. So if someone does this test on you and you have a positive result (usually a + is elicited pain/numbness/tingling or loss of a pulse), it doesn't mean anything for sure. Positive tests should be "assessed cautiously".
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CARPAL TUNNEL SYNDROME
--CTS-->median nerve compression neuropathy (pinkie & 1/2 ring finger not involved)
--swelling, inflam, pressure in tunnel
--ETIO: trauma, overuse (flex, ext, gripping, keyboard), constriction (tenosynovitis of flexor tendons, RA, osteoarthritis, ganglion or neuroma) systemic conditions (diabetes, pregnancy, obesity, hypothyroid, renal dz)
--S/Sx: pain in wrist and hand, burning, numnbness and tingling in fingers, weak thumb abduction (thenar atrophy), usu worse at night, mb retrograde pain to elbow/shoulder), "flick sign"=relief by flicking wrist as if shaking down thermometer, often bilateral but greater on one side
--Tx: avoid aggrav, ice/heat, ultrasound, laser, brace, anti-inflam, local injx
--Dx: nerve conduction velocity test 84% true positive, 95% true negative
--Tx: surgical release 80% success
--Dx: Phalen's test, Tinel's sign, weak thumb abduction, thenar atrophy
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I'm not going to rewrite the whole case, but I will summarize it here, then answer the questions. 38 yo male moves heavy stuff and wakes up one morning with a kink in his neck. It gets worse, with cramping, burning pain in his neck and shoulders. He can't sleep, and goes everywhere with his arm over his head (Bakody's sign) because that's the only position in which he gets relief from the pain. A day later he goes to the urgent care center and they prescribe narcotic pain meds and muscle relaxers, but the pt won't take them because he's a recovering addict. They don't take any xrays.
( notes on the case and answers to the homework )