Thoracic and Lumbar Special Tests

Adson’s Test

Purpose: to investigate for neurovascular TOS

Performance: examiner stands behind the patient and locates the radial pulse, the patient’s head is rotated towards the examiner, the patient then extends the head while the examiner laterally rotates and extends the patient’s shoulder, the patient is asked to take a deep breath and hold it

Positive Test: a reproduction of the patient’s cheif complaint of paresthesia in their arm and/or a disappearance of the radial pulse

Cyriax Release Test

Purpose: investigate for neurovascular TOS by increasing the costoclavicular space to try to reduce symptoms

Performance: the patient sits and folds arms across chest, the examiner stands behind and grasps the patient’s elbows and lifts superiorly, the position is held for 30 seconds

Positive Test: a reduction in symptoms

Wright Test

Purpose: investigate for neurovascular TOS by decreasing the costoclavicular space

Performance: examiner palpates the radial pulse the abducts and externally rotates the patient’s arm while flexing the elbow to 90 degrees, the patient rotates head away from the test side

Positive Test: a reproduction of the patient’s chief complaint or paresthesia in their arm, and/or a disappearance of the radial pulse

Roos Test

Purpose: investigate for neurovascular TOS

Performance: patient abducts both arms 90 degrees, laterally rotates shoulders, and flexes elbows to 90 degrees, patient then opens and closes their hands slowly for 3 minutes

Positive Test: if the patient is unable to keep the arms in the starting position for 3 minutes or suffers ischemic pain, weakness of the arm, or numbness and tingling of the hand

Cervical Rotation Lateral Flexion Test

Purpose: investigate for the presence of 1st rib hypermobility

Performance: with the patient sitting, the examiner passively and maximally rotates the cervical spine away from the side being tested. while maintaining this position, the cervical spine is gently laterally flexes as far as possible moving the ear towards the chest

Positive Test: a decrease in range of motion compared to the contralateral side