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Thoracic Outlet Syndrome (TOS) can be diagnosed using several specific physical examination tests. Some of the commonly described tests include:
Adson Test:
This test assesses compression of the subclavian artery by the anterior and middle scalene muscles.
Procedure:
1. The patient takes a deep breath.
2. The patient extends their neck backward.
3. The patient turns their head towards the affected side.
4. The examiner monitors the radial pulse.
A positive result, indicated by the diminution or disappearance of the radial pulse, suggests arterial compression. It is important to note that this test can be positive in up to 50% of asymptomatic individuals.
Costoclavicular Maneuver:
The patient retracts and depresses their shoulders posteriorly and inferiorly (similar to the posture when carrying a heavy backpack). The examiner monitors the radial pulse. A positive finding (diminished or absent pulse) suggests compression within the costoclavicular space.
Hyperabduction Maneuver (Wright's Test):
This test assesses compression in the subcoracoid space or by the pectoralis minor muscle.
Procedure:
1. The patient's arm is passively or actively abducted to 180 degrees and externally rotated.
2. The examiner monitors the radial pulse.
A positive result is indicated by the diminution or disappearance of the radial pulse, suggesting compression of the axillary artery.
Allen's Sign (TOS Variant):
This test involves positioning the patient's arm with 90 degrees of abduction, elbow flexed, and the arm in external rotation, while the head is turned to the contralateral side. The examiner then palpates the radial pulse. A diminished or absent pulse is considered a positive finding.
In addition to these physical examination maneuvers, diagnostic imaging and electrophysiological studies such as plain radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and electromyography (EMG) may be utilized to confirm the diagnosis or rule out other conditions.
What is a Thoracic Outlet Syndrome test?
Adson Test:
This test assesses compression of the subclavian artery by the anterior and middle scalene muscles.
Procedure:
1. The patient takes a deep breath.
2. The patient extends their neck backward.
3. The patient turns their head towards the affected side.
4. The examiner monitors the radial pulse.
A positive result, indicated by the diminution or disappearance of the radial pulse, suggests arterial compression. It is important to note that this test can be positive in up to 50% of asymptomatic individuals.
Costoclavicular Maneuver:
The patient retracts and depresses their shoulders posteriorly and inferiorly (similar to the posture when carrying a heavy backpack). The examiner monitors the radial pulse. A positive finding (diminished or absent pulse) suggests compression within the costoclavicular space.
Hyperabduction Maneuver (Wright's Test):
This test assesses compression in the subcoracoid space or by the pectoralis minor muscle.
Procedure:
1. The patient's arm is passively or actively abducted to 180 degrees and externally rotated.
2. The examiner monitors the radial pulse.
A positive result is indicated by the diminution or disappearance of the radial pulse, suggesting compression of the axillary artery.
Allen's Sign (TOS Variant):
This test involves positioning the patient's arm with 90 degrees of abduction, elbow flexed, and the arm in external rotation, while the head is turned to the contralateral side. The examiner then palpates the radial pulse. A diminished or absent pulse is considered a positive finding.
In addition to these physical examination maneuvers, diagnostic imaging and electrophysiological studies such as plain radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and electromyography (EMG) may be utilized to confirm the diagnosis or rule out other conditions.