Transcript Thoracic Outlet Syndrome

Thoracic Outlet Syndrome
TOS
Thoracic Outlet Syndrome
Thoracic outlet syndrome results from compression of
the subclavian vessels and brachial plexus.
Patients may complain of neck and shoulder pain with
numbness and tingling in the upper extremity.
The ulnar side is typically involved.
Using the extremity in an overhead or elevated
position is difficult.
Clinical Signs and Symptoms
Upper extremity pain.
Upper extremity paresthesias.
Grip weakness.
Clinical Signs and Symptoms
Upper extremity edema.
Upper extremity coldness.
Excessive dryness of the arm or hand.
Excessive sweating of the arm or hand.
Thoracic Outlet
Thoracic Outlet
Adson’s Test
Procedure:
Patient seated – establish amplitude of pulse.
Compare amplitude b/l.
Deep breath. Rotate head and elevate chin to side
being tested.
Repeat to opposite side.
Positive Test:
A decrease or absence of the radial pulse.
Paresthesias or radiculopathy in the upper extremity.
Adson’s Test
Structures Affected:
Compression of the vascular component of the
neurovascular bundle (subclavian artery) by one of the
following:
Spastic or hypertrophied scalenus anterior muscle
Cervical rib
Mass such as a Pancoast tumor.
Compression of the neural component of the
neurovascular bundle (brachial plexus).
Adson’s Test
Costoclavicular Test
Procedure:
Patient seated – establish radial pulse.
Patient force shoulders posterior and flex chin to chest.
Positive Test:
Decrease or absence of the radial pulse.
Paresthesias or radiculopathy in the upper extremity.
Costoclavicular Test
Structures Affected:
Compression is caused by a decrease in the space
between the clavicle and the first rib.
A recent or healed fracture of the clavicle or first rib
with or without callus formation, dislocation of the
medial aspect of the clavicle, or spastic or hypertrophied
subclavius muscle could cause the compression.
Costoclavicular Test
Wright’s Test
Procedure:
Patient seated – establish radial pulse.
Hyperabduct the arm and take the pulse again.
Positive Test:
Decrease or absence of the radial pulse.
Structures Affected:
Compression of the axillary artery by a spastic or
hypertophied pectoralis muscle or a deformed or
hypertrophied coracoid process.
Wright’s Test
Traction Test
Procedure:
Patient seated – establish radial pulse.
Maintain pulse, extend and traction arm.
Positive Test:
A decreased or obliterated pulse alone is not diagnostic;
however, when if the test is repeated on the other side
and reveals no change it is positive.
Structures Affected:
A subluxated or malpositioned first rib or a cervical rib.
Traction Test
Halstead Maneuver
Procedure:
Patient seated – establish radial pulse and note
amplitude.
With opposite hand, pull on the patient’s arm and have
him hyperextend the neck.
Repeat on opposite side.
Positive Test:
Decrease or absence of the radial pulse.
Radiculopathy in the upper extremity.
Halstead Maneuver
Structures Affected:
Decrease or absence of the pulse indicates a cervical rib,
subluxation, or malposition of the first rib.
A radicular component indicates compression of the
brachial plexus by the scalenus anterior muscle.
Halstead Maneuver
Bracial Plexus Irritation
Irritation of the brachial plexus may be due to various
factors such as the following:
Cervical rib
Severe upper traction of the arm
Fractured clavicle
Pulmonary apical mass
Clinical Signs and Symptoms
Upper extremity radicular pain
Upper extremity paresthesias
Grip weakness
Brachial Plexus Stretch Test
Procedure:
Patient seated.
Laterally flex the head opposite to the side affected.
Extend the shoulder and elbow on the affected side.
Brachial Plexus Stretch Test
Positive Test:
Pain and/or paresthesia along the distribution of the
brachial plexus.
Pain on the side of lateral bending may indicate a nerve
root problem.
Local cervical pain on the side of bending could be a
facet joint problem on that side.
Brachial Plexus Stretch Test