ONE Thoracic Outlet Syndrome

Question 1

Roo’s Test

Answer 1

Presence of TOS
• Both arms 90 abduction, 90 elbow flexion
• External rotation
• Open and close hands 1-3 minutes
• + pain, heaviness, weakness, numbness, paresthesia

Question 2

Adson’s Maneuver

Answer 2

This is the only test where you hold your breath**

Presence of TOS
• Patient seated – establish amplitude of pulse
• Extend arm to end of range of motion. Rotate head ipsilaterally , elevate chin • lengthens scalene
• Deep breath hold 20 seconds (anterior and middle scalene elevates 1st rib)
• Repeat to opposite side. Compare pulse amplitude bilaterally
• + Radial pulse diminishes or disappears
• + Paresthesia or radiculopathy in the upper extremity
• Compression of the neurovascular component of the neurovascular bundle (brachial plexus, subclavian artery)
• Spastic or hypertrophied scalenus anterior muscle
• Cervical rib
• Mass such as a Pancoast tumor (apex of lung)

Question 3

Halstead Maneuver

Answer 3

Presence of TOS
• Patient seated – establish radial pulse, note amplitude • Extend arm with caudal traction
• Patient rotate head contralaterally
• Repeat on opposite side
• +Decrease or absence of the radial pulse
• +Radiculopathy in the upper extremity – anterior scalene • Tractions brachial plexus, shortens ipsilateral scalene
• Cervical rib, subluxation, or malposition of the first rib.