Thoracic Outlet Syndrome Tests- Lab Flashcards
1
Q
ULNTT-A
A
- Examines neural tissue passing through the TOS container under a tension load
- Patient supine. Examiner standing on the side to be tested.
- Examiner depresses the shoulder girdle and abducts the shoulder to 110 degrees with slight extension and elbow flexion to 90 degrees. The forearm is then maximally supinated and the wrist and fingers extended. Finally, elbow extension is applied. The neck is sidebent to the contralateral side.
- Testing is stopped after any symptom reproduction.
- Positive test: reproduction of symptoms with the distal movement or neck movement and/or restricted elbow extension range of motion.
2
Q
Elevated arm stress test
A
- Loading the plexus throughout the TOS container
- Patient seated with arms above 90 degrees of abduction and full external rotation with head in neutral position.
- Patient opens and closes hands into fists while holding the elevated position for 3 minutes.
- Positive test: pain and/or paresthesia and discontinuation with dropping of the arms for relief of pain
3
Q
Adson’s Test
A
- AT and SCP = more specifically address compromise to the plexus through the scalene triangle
- Patient seated with arms at the side. The radial pulse is palpated.
- Patient inhales deeply and holds the breath, extends and rotates the neck toward the side being tested.
- Positive test: change in radial pulse and/or pain, paresthesia reproduction
4
Q
Wright’s test
A
- Neural tissue compromise through the thoraco-coraco-pectoral gate
- Patient seated with arms at the side. The radial pulse is palpated.
- Examiner places the patient’s shoulder into abduction above the head. The position is held for 1 to 2 minutes.
- Positive test: change in radial pulse and/or symptom reproduction.
5
Q
Costoclavicular manuver
A
- Costoclavicular space narrowing
- Patient sits straight with arms at the side. Radial pulse is assessed.
- Patient retracts and depresses shoulders while protruding the chest. Position is held for up to 1 minute.
- Positive test: change in radial pulse and/or pain and paresthesia.
6
Q
Cyriax release
A
- Examines the result of unloading the plexus in the TOS container
- Patient seated or standing. Examiner stands behind patient and grasps under the forearms, holding the elbows at 80 degrees of flexion with the forearms and wrists in neutral. Examiner leans the patient’s trunk posteriorly and passively elevates the shoulder girdle. The position is held for up to 3 minutes.
- Positive test: Paresthesia and/or numbness (release phenomenon) or symptom reproduction.
7
Q
Supraclavicular pressure
A
- AT and SCP = more specifically address compromise to the plexus through the scalene triangle
- Patient seated with arms at the side. Examiner places fingers on the upper trapezius and the thumbs contacting the anterior scalene muscle near the first ribs and squeezes the fingers and thumb together for 30 seconds.
- Positive test: reproduction of pain or paresthesia.
8
Q
TOS provocation tests
A
- Tests display fairly large percentage of false positives when a change in the radial pulse is considered as a positive finding
- Clinicians are encouraged to use the test position of those tests for symptom provocation and not as a test for radial pulse change à sensible considering low incidence of vascular TOS
- Wright’s + EAST = SNout neurogenic and vascular TOS
- ULNTT=Snout irritation of neural tissue: plexus,root; used for examination and treatment
9
Q
Cervical rotation-lateral flexion
A
- Mobility of the 1st rib as an elevated 1st rib can potentially increase the tension on the neurovascular bundle of the brachial plexus
- Patient seated. Examiner passively rotates the head away from the affected side and gently flexes the neck forward to end range moving the ear toward the ventral chest.
- Positive test: forward flexion part of the movement is notably decreased with a hard end feel.
10
Q
ROOS test
A
11
Q
Morley sign
A
12
Q
Tinels sign
A
13
Q
Diagnostic cluster (Gilliard cluster for TOS)
A
14
Q
Hyperabduction test
A
15
Q
First rib spring test
A
