Orthopedic Diagnosis: Thoracic Spine and TOS

Question 1

Adam Sign

Answer 1

1. Positive: A “c” or “s” shaped scoliosis is observed to straighten
   
   • Indicates: Negative - Evidence of a functional scoliosis, trauma or subluxation
2. Positive: A “c” or “s” shaped scoliosis does not straighten (look for rib humping, muscular imbalance and asymmetry in hand length)
   
   • Indicates: Positive - Evidence of a pathologic or structural scoliosis

Question 2

Adam Positions

Answer 2

1. Positive: A “c” or “s” shaped scoliosis is observed to straighten
   
   • Indicates: Negative - Evidence of functional scoliosis, trauma or subluxation
2. Positive: A “c” or “s” shaped scoliosis does not straighten (look for rib humping, muscular imbalance and asymmetry in hand length)
   
   • Indicates: Positive - Evidence of pathologic or structural scoliosis

Question 3

Schepelmann Sign

Answer 3

1. Positive: Pain on the concave side
   
   • Indicates: Intercostal neuritis
2. Positive: Pain on the convex side
   
   • Indicates: Fibrous inflammation of the pleura or possible intercostal myofascitis

Question 4

Beevor Sign

Answer 4

1. Positive: Superior movement of the umbilicus
   
   • Indicates: Spinal cord lesion at the level of T11-T12 or lower abdominal weakness
2. Positive: Inferior movement of the umbilicus
   
   • Indicates: Nerve root involvement T7-T10

Question 5

Roos Test

Answer 5

• Positive: Ischemic pain, heaviness of the arms or numbness an tingling of the hand
  
  • Indicates: Thoracic outlet syndrome on side involved (Evan’s considers this test to be most accurate for TOS evaluation)

Question 6

E.A.S.T.

Answer 6

• Positive: Ischemic pain, heaviness of the arms or numbness and tingling of the hand
  
  • Indicates: Thoracic outlet syndrome on side involved (Evan’s considers this test to be most accurate for TOS evaluation)

Question 7

Elevated Arm Stress Test

Answer 7

• Positive: Ischemic pain, heaviness of the arms or numbness and tingling of the hand
  
  • Indicates: Thoracic outlet syndrome on side involved (Evan’s considers this test to be most accurate for TOS evaluation)

Question 8

Adson Test

Answer 8

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib

Question 9

Scalene Maneuver

Answer 9

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib

Question 10

Scalenus Anticus Test

Answer 10

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib

Question 11

Halstead Maneuver

Answer 11

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib

Question 12

Costoclavicular Maneuver

Answer 12

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the neurovascular bundle between the clavicle and 1^st rib

Question 13

Eden Test

Answer 13

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of neurovascular bundle between the clavicle and 1^st rib

Question 14

Hyperabduction Maneuver

Answer 14

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the axillary artery by pectoralis minor or coracoid process. Thoracic outlet syndrome

Question 15

Wright Test

Answer 15

• Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor
  
  • Indicates: Compression of the axillary artery by pectoralis minor or coracoid process. Thoracic outlet syndrome

Question 16

Naffziger Test

Answer 16

• Positive: Radicular pain (typically in lumbars, possibly cervical or thoracic)
  
  • Indicates: Space occupying lesion