Thoracic Outlet Syndrome Flashcards
1
Q
Roo’s Test
A
- Also known as the Elevated Arm Stress Test (EAST)
- This test is considered the most reliable of the TOS tests for the vascular subtypes of TOS however it is non-specific
- The test supposedly tests all three sites of potential compression: scalene, costoclavicular and axillary
Purpose:
- To test for compromise of the neurovascular structures that pass through the brachium
- Roo’s test causes a narrowing of the costoclavicular space as well as tightening of the cervical muscles
- Reported to be useful for the detection of vascular forms of TOS
Procedure:
- Patient is sitting or standing
- The practitioner stands near the patient in order to observe for symptoms and enquire as to what the patient is experiencing during the performance of the test
- The patient abducts the arms to 90° and externally rotates the shoulders, flexes the arms to 90° and horizontally abducts the arms so that the elbows are slightly behind the coronal plane
- The patient then opens and closes their hands slowly (once every 2 seconds) for 3 minutes
Positive:
- The experience of minor fatigue and distress are not considered positive test results
- A positive test is indicated if the patient can not keep the arms up in the starting position for 3 minutes or the patient experiences ischemic pain, profound weakness, arm heaviness or numbness and tingling of the hand during the performance of the test
Indication of positive:
- Must first rule out other causes of vascular and neurological compromise e.g. Pancoast tumor
- Thoracic Outlet Syndrome
Clinical Note:
- A test should only be considered positive if it reproduces the patient’s symptoms exactly
2
Q
Adson Maneuver
A
Purpose:
- To test for compression of the neurovascular bundle by the scalene muscles i.e. Scalenus-anticus syndrome
Procedure:
- The patient is sitting
- The practitioner stands behind the patient
- The practitioner locates the patient’s radial pulse and asks the patient to rotate their head toward the test shoulder
- The practitioner then externally rotates and extends the patient’s arm
- The patient is instructed to extend the neck and take a big breath in and hold it
- The test position is held for approximately 30 seconds
Positive:
- Symptom reproduction, with or without a disappearance of the radial pulse, indicates a positive test
Indication of positive:
- Must first rule out other causes of vascular and neurological compromise e.g. Cervical Radiculopathy
- Thoracic Outlet Syndrome
Clinical Note:
- Due to the unknown reliability of the TOS tests, a test should only be considered positive if it reproduces the patient’s symptoms exactly
3
Q
Halstead Maneuver
A
Purpose:
- To test for compression of the neurovascular bundle in the costoclavicular space
Procedure:
- The patient is sitting
- The practitioner stands behind the patient and locates the patient’s radial pulse
- The practitioner abducts the patient’s the arm to 45 degrees, extends the shoulder to 45 degrees, externally rotates the humerus, and applies a downward traction to the arm.
- The patient is then asked to turn their head to the contralateral side and extend their cervical spine
- The practitioner then applies a downward traction on the extremity
- This position is held for approximately 30 seconds
Positive:
- Symptom reproduction, with or without a disappearance of the radial pulse, indicates a positive test
Indication of positive:
- Must first rule out other causes of vascular and neurological compromise e.g. Carpal tunnel syndrome
- Thoracic Outlet Syndrome
Clinical Note:
- Due to the unknown reliability of the TOS tests, a test should only be considered positive if it reproduces the 42 patient’s symptoms exactly
4
Q
Costoclavicular Maneuver
A
Purpose:
- To test for compression of the neurovascular bundle in the costoclavicular space
Procedure:
- The patient is sitting
- The practitioner stands behind the patient
- The practitioner palpates the patient’s radial pulses and draws the patient’s shoulders down and into extension
- The patient is asked to maximally flex their neck
- The position is held for approximately 30 seconds
Positive:
- Symptom reproduction, with or without a disappearance of the radial pulse, indicates a positive test
Indication of Positive:
- Must first rule out other causes of vascular and neurological compromise e.g. Brachial Neuritis
- Thoracic Outlet Syndrome
Clinical Note:
- Due to the unknown reliability of the TOS tests, a test should only be considered positive if it reproduces the patient’s symptoms exactly
5
Q
Wright Maneuver
A
Purpose:
- To test for thoracic outlet syndrome as a result of costoclavicular syndrome and/or pectoralis minor syndrome
Procedure:
- The patient is sitting
- The practitioner stands behind the patient
- The practitioner palpates the radial pulse, externally rotates and hyperabducts the patient’s arm
- The test can be repeated with additional provocative steps:
- Having the patient take a breath in and hold it
- Having the patient rotate to the contralateral side with the head extended
Positive:
- Symptom reproduction, with or without a disappearance of the radial pulse, indicates a positive test
Indication of positive:
- Must first rule out other causes of vascular and/or neurological compromise
- Thoracic Outlet Syndrome
Clinical Note:
- Due to the unknown reliability of the TOS tests, a test should only be considered positive if it reproduces the patient’s symptoms exactly
