{"id":1047,"date":"2010-12-03T18:26:04","date_gmt":"2010-12-03T18:26:04","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/test-for-suspected-thoracic-outlet-syndrome\/"},"modified":"2024-02-29T17:17:07","modified_gmt":"2024-02-29T17:17:07","slug":"test-for-suspected-thoracic-outlet-syndrome","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-upper-extremities\/the-shoulder-girdle\/test-for-suspected-thoracic-outlet-syndrome\/","title":{"rendered":"Test For Suspected Thoracic Outlet Syndrome"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>T<\/strong><strong>horacic outlet syndrome\u00a0<\/strong><span style=\"color: #003366;\">(TOS)<\/span><\/span> is a <span style=\"text-decoration: underline;\">neuro-vascular syndrome<\/span> which refers to three related syndromes involving compression of the <span style=\"color: #33cccc;\"><strong>nerves<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>arteries<\/strong><\/span>, and <span style=\"color: #33cccc;\"><strong>veins<\/strong><\/span> in the lower neck and upper chest. The diagnostic tests described below are not very specific and are only of limited diagnostic value. If the patient complains of <span style=\"color: #33cccc;\"><strong>vague shoulder pain<\/strong><\/span> with <span style=\"color: #33cccc;\"><strong>tingling of the arm<\/strong><\/span>, the tests described below can be used to assess whether one of the following syndromes are involved:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Scalenus syndrome.<\/span><\/li>\n<li><span style=\"color: #003366;\">Costo-clavicular compression syndrome (<em>CCCS<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Hyper-abduction syndrome.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>Before carrying out the tests, the radial artery should be palpated bilaterally.<\/em><\/span><\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124036544?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Adson\u2019s Test<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">During this test, the <span style=\"color: #33cccc;\"><strong>inter-scalene space<\/strong><\/span> will be made smaller, causing <span style=\"text-decoration: underline;\">increased compression<\/span> of the <span style=\"color: #33cccc;\"><strong>subclavian artery<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>brachial plexus<\/strong><\/span> (<em>particularly C8 and T1<\/em>) against the <span style=\"color: #33cccc;\"><strong>first<\/strong><strong>\u00a0rib<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Bring the patient\u2019s outstretched arm backwards in <span style=\"color: #33cccc;\"><strong>retroflexion<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>adduction<\/strong><\/span>, and palpate the <span style=\"color: #33cccc;\"><strong>radial artery<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Ask the patient turn their head to the <span style=\"text-decoration: underline;\">homo-lateral side<\/span>, whilst stretching the neck as much as possible.<\/span><\/li>\n<li><span style=\"color: #003366;\">Support this movement with your other hand.<\/span><\/li>\n<li><span style=\"color: #003366;\">Ask the patient to inhale and hold their breath for a short period<em><strong> [Figure 58]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1043\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-58.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-58.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-58-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 58<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Repeat the test with the head turned to the <span style=\"text-decoration: underline;\">hetero-lateral side<\/span> <em><strong>[Figure 59]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1044\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-59.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-59.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-59-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 59<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Pay attention to a <span style=\"color: #33cccc;\"><strong>reduction<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>possible absence<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>radial pulse<\/strong><\/span>, and note whether signs of <span style=\"color: #33cccc;\"><strong>neurological irritation<\/strong><\/span> are evoked or aggravated. The test is positive if both above mentioned phenomena occur in step 2\/step 5 and the result for the contralateral side is negative.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Costoclavicular Manoeuvre (Military Brace)<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">During this test, the cluster of <span style=\"color: #33cccc;\"><strong>blood vessels<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>nerves<\/strong><\/span> in the <span style=\"color: #33cccc;\"><strong>costoclavicular space<\/strong><\/span> may be compressed.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to move the shoulder(<em>s<\/em>) backwards and downwards.<\/span><\/li>\n<li><span style=\"color: #003366;\">The examiner can, if necessary, exert further traction on the patient\u2019s arm(<em>s<\/em>)<em><strong> [Figure 60]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Palpate the radial artery (<em>bilaterally<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1045\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-60.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-60.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-60-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 60<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Note any <span style=\"color: #33cccc;\"><strong>reduction<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>possible absence<\/strong><\/span> of <span style=\"color: #33cccc;\"><strong>radial pulse<\/strong><\/span>, and whether signs of <span style=\"color: #33cccc;\"><strong>neurological irritation<\/strong><\/span> are evoked or aggravated. The test is positive if both above mentioned phenomena occur and the result for the contralateral side is negative.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Hyperabduction Manoeuvre (Wright&#8217;s Test)<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">During this test, the cluster of <span style=\"color: #33cccc;\"><strong>blood vessels<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>nerves<\/strong><\/span> (<em>subclavian artery and vein of the brachial plexus<\/em>) can be compressed at the following locations:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Between the <span style=\"color: #33cccc;\"><strong>coracoid process<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>pectoralis minor muscle<\/strong><\/span> on one side and the thoracic wall on the other side.<\/span><\/li>\n<li><span style=\"color: #003366;\">Between the <span style=\"color: #33cccc;\"><strong>first rib<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>clavicle<\/strong><\/span> (<em>during abduction of the arm, the clavicle turns around the longitudinal axis, during which the curve of the clavicle can cause compression<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to abduct and rotate their arm(<em>s<\/em>) outwards. <\/span><\/li>\n<li><span style=\"color: #003366;\">Support this movement if necessary <em><strong>[Figure 61]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Palpate the <span style=\"color: #33cccc;\"><strong>radial artery<\/strong><\/span> (<em>bilaterally<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1046\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-61.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-61.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-61-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 61<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Pay attention to a <span style=\"color: #33cccc;\"><strong>reduction<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>possible absence<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>radial pulse<\/strong><\/span>, and note whether any signs of <span style=\"color: #33cccc;\"><strong>neurological irritation<\/strong><\/span> are evoked or aggravated. <\/span><span style=\"color: #003366;\">The test is positive if both above mentioned phenomena occur and the result for the contralateral side is negative.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thoracic outlet syndrome\u00a0(TOS) is a neuro-vascular syndrome which refers to three related syndromes involving compression of the nerves, arteries, and veins in the lower neck and upper chest. The diagnostic tests described below are not very specific and are only of limited diagnostic value. If the patient complains of vague shoulder pain with tingling of [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[62],"tags":[141],"class_list":["post-1047","post","type-post","status-publish","format-standard","hentry","category-the-shoulder-girdle","tag-the-examination-of-the-upper-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Test For Suspected Thoracic Outlet Syndrome - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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