Thoracic Outlet Syndrome (TOS) Evaluation

Question 1

Procedure for Allen’s Test

Answer 1

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)

Question 2

Purpose/Function of Allen’s Test

Answer 2

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

Question 3

Finding for Allen’s Test

Answer 3

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

Question 4

Procedure for Adson’s Test

Answer 4

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

Question 5

Purpose/Function of Adson’s Test

Answer 5

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

Question 6

Compressive component with a positive Adson’s Test:

Answer 6

Scalenus Anticus

Question 7

Findings for Adson’s Test

Answer 7

This test is positive if there is paresthesia and/or a decrease in the amplitude of the radial pulse

Question 8

Procedure for Modified Adson’s Test

Answer 8

Same as Adson’t test except the patient rotates the head to the opposite side being tested (contralateral side)

Question 9

Purpose/Function of Modified Adson’s Test

Answer 9

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

Question 10

Compressive component with a positive Modified Adson’s Test

Answer 10

Scalenus Medius

Question 11

Findings for Modified Adson’s Test

Answer 11

Same as Adson’s Test

Question 12

Procedure for Halstead’s Test

Answer 12

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

Question 13

Purpose/Function of Halstead’s Test

Answer 13

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

Question 14

Findings for Halstead’s Test

Answer 14

Same as Adson’s test. This test is positive if there is paresthesia and/or a decrease in the amplitude of the radial pulse

Question 15

Compressive component with a positive Halstead’s Test

Answer 15

cervical rib, scalenus medius

Question 16

Procedure for Allen’s Maneuver

Answer 16

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

Question 17

Clinical indications for Allen’s Maneuver

Answer 17

The disappearance of the pulse indicates a positive test result for thoracic outlet syndrome

Question 18

Procedure for Roos’ Test

Answer 18

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.

Question 19

Roos’ Test is also known as

Answer 19

Hands up Test aka Hostage Test

Question 20

Function of Roos’ Test

Answer 20

This position stresses the thoracic outlet area

Question 21

Findings for Roos’ Test

Answer 21

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

Question 22

Compressive component for Roos’ Test

Answer 22

Compressive component could be anything. If all other tests are negative, arterial sclerosis

Question 23

Procedure for Wright’s Test

Answer 23

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

Question 24

Wright’s Test is also known as

Answer 24

Hyperabduction Test

Question 25

Function of Wright’s Test

Answer 25

This test compresses the Axillary artery under the Pectoralis Minor muscle

Question 26

Compressive component for Wright’s Test

Answer 26

Pectoralis Minor

Question 27

Findings for Wright’s Test

Answer 27

Many patients have cessation of the radial pulse upon abduction of the arm in the absence of this syndrome. For this reason the non-affected side is used for comparison. If the non-affected limb shows Radial pulse dampening or cessation both actively and passively at the same degree of abduction as the affected side, the test may be demonstrating a false positive

Question 28

Procedure for Costoclavicular (Eden’s) Test

Answer 28

The patient is in the seated position with the arms resting on the thighs and the palms facing up. The doctor palpates the Radial pulses and notes the rate, rhythm, and amplitude. The patient is then instructed to actively draw the shoulders backward, lower the chin to the chest and take a deep breath, holding for a ten count

Question 29

Costoclavicular Test is also known as

Answer 29

Eden’s Test, “Backpackers syndrome”

Question 30

Purpose of Costoclavicular/Eden’s Test

Answer 30

To narrow the space between the clavicle and the first rib, thus compressing the neurovascular tissues of the subclavian artery, vein, and brachial plexus

Question 31

Function of Costoclavicular/Eden’s Test

Answer 31

The above procedures narrow the space between the clavicle and the first rib cause by: poor posture, cervical rib, bone tumor, or poorly united fracture of the clavicle

Question 32

Findings for Costoclavicular/Eden’s Test

Answer 32

A positive test is noted by any of the following signs: Cessation or dampening of the radial pulse
Ischemic color changes
Paresthesia
Radicular pain in the upper limb