Thoracic Outlet Syndrome (TOS) Evaluation Flashcards
Procedure for Allen’s Test
The patient is in the seated position with the forearms resting on thighs, palms up. The patient is instructed to open and close the hand on the side being tested five times, maintaining a tight fist after the fifth repetition. The doctor digitally occludes both the Radial and Ulnar artery just proximal to the wrist while the patient is still clenching the hand. With the doctor maintaining the occlusion, the patient opens the hand and the doctor then releases one of the arteries and compares color return of the hand to the contralateral side. Repeat the procedure on remaining vessels. (ulnar may take a couple sec. longer than radial)
Purpose/Function of Allen’s Test
To test the patency of the upper extremity arterial system. Function: To occlude vascular flow to the hand in order to observe the filling time required by each vessel
Finding for Allen’s Test
Delayed color return during digital compression indicates partial blockage, while no color return until compression is removed indicated complete blockage of the artery which has not been compressed or possible occlusion of the common vessel. Normal time for color return is less than 5 sec. May be subclavian compression if the filling time in the hands are different
Procedure for Adson’s Test
With the patient seated the doctor palpates the radial pulse to determine its rate, rhythm, and amplitude. The doctor maintains palpation of the pulse while slightly abducting and externally rotating the patient’s arm. The patient is then instructed to: rotate the head to the side being tested, extend the neck as far as possible, and take a deep breath and hold for a 10 count
Purpose/Function of Adson’s Test
To test for neurovascular compression of the subclavian artery and/or brachial plexus. Function: Hypertrophy of the Scalenus Anticus muscle and/or cervical rib; commonly causes compression of the neurovascular bundle on the ipsilateral side
Compressive component with a positive Adson’s Test:
Scalenus Anticus
Findings for Adson’s Test
This test is positive if there is paresthesia and/or a decrease in the amplitude of the radial pulse
Procedure for Modified Adson’s Test
Same as Adson’t test except the patient rotates the head to the opposite side being tested (contralateral side)
Purpose/Function of Modified Adson’s Test
To test for neurovascular compression of the subclavian artery/or brachial plexus. Function: Same as Adson’t test except the Scalenus Medius muscle is being tested as well as cervical rib involvement
Compressive component with a positive Modified Adson’s Test
Scalenus Medius
Findings for Modified Adson’s Test
Same as Adson’s Test
Procedure for Halstead’s Test
With the patient seated and arms at the sides, the doctor palpates the radial pulse to determine its rate, rhythm, and amplitude. The doctor maintains palpation of the pulse while pulling downward on the affected arm while the patient hyperextends the neck. If there is a drop in amplitude of the pulse it is a positive test. If no change is noted the patient rotates the head to the opposite side.Palpate pulse, pull down on the arm, extend the neck as far as possible, rotate the head to the opposite side being tested, take a deep breath and hold for 10 count
Purpose/Function of Halstead’s Test
To test for neurovascular compression of the Subclavian artery and brachial plexus. Function: Same as Adson’s test except the Scalenus Medius muscle is being tested as well as cervical rib involvement
Findings for Halstead’s Test
Same as Adson’s test. This test is positive if there is paresthesia and/or a decrease in the amplitude of the radial pulse
Compressive component with a positive Halstead’s Test
cervical rib, scalenus medius
Procedure for Allen’s Maneuver
The examiner abducts the shoulder to 90 degrees and flexes the patient’s elbow to 90 degrees then the shoulder is externally rotated. The patient then rotates the head away from the test side. The examiner palpates the Radial pulse. If the pulse disappears when the head is rotated it indicates a positive test for Thoracic Outlet Syndrome. When doing any thoracic outlet test, the examiner must find the pulse before positioning the patient. In a normal individual, the pulse may be diminished
Clinical indications for Allen’s Maneuver
The disappearance of the pulse indicates a positive test result for thoracic outlet syndrome
Procedure for Roos’ Test
The patient’s arms are elevated to 90 degrees, elbows are flexed to 90 degrees and the shoulders are externally rotated. The patient then opens and closes the fist for three minutes to see if this will reproduce the patients’ symptoms.
Roos’ Test is also known as
Hands up Test aka Hostage Test
Function of Roos’ Test
This position stresses the thoracic outlet area
Findings for Roos’ Test
Tingling or paresthesia often in the ulnar side of the forearm and hand. This test was found to reproduce symptoms in 91% of 315 thoracic outlet patients tested
Compressive component for Roos’ Test
Compressive component could be anything. If all other tests are negative, arterial sclerosis
Procedure for Wright’s Test
The patient is in the seated position with the arms at the side. The doctor stands to the side or behind favoring the side being tested. With the doctor palpating the Radial pulse, the arm is abducted to 180 degrees passively, the doctor noting at how many degrees of abduction the Radial pulse on the affected side diminishes or disappears when compared to the opposite side
Wright’s Test is also known as
Hyperabduction Test
