Ortho
6/4/99

•	Evan’s keep in mind that you would like to reproduce the paresthesia w/ or w/o pain
•	Video on whiplash

Thoracic outlet syndrome
•	Clavicle
•	First rib
•	Subclavian
•	Scalenes
•	Normally there is plenty of room for structures to exit
•	Insertion of the anterior scalene may have a wide insertion and take up some of the area
•	Short vertical position
•	Cervical rib from the posterior—bridging across
•	Some of these have been present all of their lives and now they have become symptomatic on Tuesday—these pts have a very good prognosis—something must have caused a change
•	Lateral flexion problems and uncinate joints of lower cervical area
•	Costoclavicular fixation—1st rib, sternoclavicular, acromionclavicular
•	Pec minor/coracoid—scapuloclavicle, sternal injury
•	Hyperabduction (TOS)—pec minor coracoid
•	Hyperabduction—dual compression in some areas—clavicle/1st rib and pec minor/coracoid
TMJ
•	Review the anatomy of the area
•	Masseter—2 portions—superficial and deep—close the jaw, very powerful
•	Temporalis—big sheet of muscle, large tendon
•	Lateral pterygoid—disc insertion, pulls head of condyle and disc forward, medial to lateral orienation
•	Fiber cartilagenous disc, mobile
•	Medial pterygoid—inside angle of the jaw
1.	inspection—opening:  at least two knuckles or a range b/w 35 and 50 mm; deviation (returns to midline) and deflection (out at an angle and remains off to the side)
2.	palpation—muscles:  O/I masseter, temporalis, lateral pterygoid and insertion of medial pterygoid—TM Joint
3.	noise—crepitus (minor degeneration of the artciluar surfaces), intra articular disc gets stuck and pops back into place (either on opening or closing)