Thoracic Ortho Exams

Question 1

The patient is seated with elbow flexed and forearm supinated, ask pt to pump the hand, keep closed while examiner occludes the radial and ulnar arteries until hand is blanched. The pt slowly opens the hand while the doctor opens one artery and records the filling time. Repeat for other artery.

Answer 1

Allen’s Test
(+) = Delay of more than 10 seconds for blood to return
Occlusion of the corresponding artery

Question 2

With the patient seated, doctor slightly abducts, extends and externally rotates the arm while taking the radial pulse. Pt rotates head toward tested side and extends head. Pt takes deep breath.

Answer 2

Adson’s Test aka Scalenus Anticus Test
(+) = Alteration in amplitude of radial pulse
Cervical Rib

Question 3

What tests check for Cervical Rib

Answer 3

Adson’s and Halstead’s

Question 4

If Adson’s test was negative, the patient then rotates head to the opposite side, extends head and takes a deep breath.

Answer 4

Modified Adson’s Test aka Scalenus Medius Test
(+) = Alteration in the amplitude of radial pulse
Subclavian artery, Scalenus medius syndrome

Question 5

The doctor palpates the radial pulse while drawing the patients shoulder down and back. The pt flexes chin to chest.

Answer 5

Costoclavicular Maneuver aka Eden’s Test
(+) = Alteration in the amplitude of radial pulse
Compression between first rib and clavicle

Question 6

Patient is seated while doctor palpates radial pulse. Each arm is individually abducted to 180 degrees. The doctor notes angle at which radial pulse diminishes or disappears.

Answer 6

Wright’s Test aka Hyperabduction Maneuver
(+) = if pulses are lost with more than 10 degree difference
Pectoralis Minor Syndrome, Axillary artery

Question 7

While seated, patient actively places palm on top of the head.

Answer 7

Reverse Bakody Maneuver

(+) = Increased pain

Question 8

Patient extends the head back. The examiner slightly abducts arm then applies downward traction on arm while taking pulse.

Answer 8

Halstead’s Test
(+) = Alteration in amplitude of radial pulse
Cervical Rib

Question 9

Patient actively abducts the shoulder to 90 degrees with the elbow flexed to 90 degrees and then extends the shoulder. No patient extends the elbow.

Answer 9

Bikele’s Sign
(+) = Resistance and increased radicular pain
TOS, Brachial Plexus Neuritis, Meningeal Irritation

Question 10

Patient seated. Both arms are at 90 degrees then patient abducts and externally rotates them. The patient then repeatedly opens and closes the fists for 3-5 minutes.

Answer 10

Roo’s Test
(+) = reproduction of the symptoms or unusual discomfort
TOS