Exam 2- Thoracic Outlet Syndrome

Thoracic outlet syndrome is from?

Compression of the subclavian artery

What test do you have to do first when looking for Thoracic outlet syndrome?

Allen`s test

Describe Allen's test

Patient seated palm supinated and pump their fist with arm bent upwards

Occlude the radial and ulnar artery

Bring arm down and let go of radial or ulnar artery (1 at a time)

Repeat for the other artery

Watch for blood flow to come back

Describe Adson`s test

Seated with palms up

Slightly abduct their arm and palpate radial pulse

Rotate head towards shoulder being tested

Extends neck and takes a deep breath and holds it

Palpate for loss of pulse amplitude

Ask pain

A diminished pulse in Adson`s test indicates?

Compression of the subclavian artery between the SCALENE ANTICUS and first rib

Look towards the affected side for _________ and rotate head away for______

Toward= scalenus anticus

Away= scalenus medius

Modified Adson`s test

Same as adsons but turn head away now

Diminished pulse with modified adsons test indicates?

Compression of subclavian artery between SLACENUS MEDIUS and the first rib

Halstead`s test is typically done when a patient comes in saying what?

Fingers go numb when carrying groceries or something heavy like that

Halstead`s test

Arms at sides, palm supinated

Examiner abducts arm and palpates radial pulse

Rotate head towards opposite shoulder

Extends neck, deep breath hold it

Apply downward traction on extremity

Feels for loss of pulse amplitude

Ask pain

A diminished pulse with halstead`s test means?

Compression of subclavian artery between scalenus medius and the first rib

If modified adson`s test was negative and halstead`s test was positive, you would have to consider?

Saggy Shoulder syndrome

Allen`s Maneuver

Palpate radial pulse

Abduct patients shoulder to 90 and patient elbow flexed to 90 and then shoulder externally rotated

Rotate head to opposite side

Radial pulse assessed for loss of amplitude

Ask for pain

A diminished pulse with Allen`s maneuver means what?

Compression of sublcavian- doesn't tell by what though

What is important with Allen`s maneuver

The amplitude naturally drops so you have to compare to the opposite side, starting with asymptomatic side first

A positive allen`s maneuver patient may come in with what history?

Arms going numb when reaching over head

What is one of the best tests for Thoracic Outlet Syndrome but doesn't tell you what is doing the compression?

Roo`s test

Roo`s test

Both patients arms abducted to 90 and externally rotated and elbows bent to 90

Patient repeatedly opens and closes fists for 3 minutes

Ask pain

What is a considered a positive Roo`s test

Patients numbness and tingling is reproduced or if the patient cannot keep their shoulders abducted to 90 cause of their pain, numbness or tingling

The Roos test was found to reproduce symptomless in __________ of patients with thoracic outlet syndrome

91%

What is the AKA for wrights test

Hyper abduction maneuver

Wrights test

Seated with arms hanging

Palpate radial pulse

Passively abduct shoulder to 180 (asymptomatic side first)

Notes angle where radial pulse is decreased or stops

Repeat opposite side and compare the angle

Ask if pain

What is considered to be a positive Wright`s test

Patients radial pulse stops or decreases at a lower degree of shoulder abduction on the symptomatic side than it does asymptomatic side

A positive wrights test tells us?

Compression of axillary artery under pectoralis minor muscle

Costoclavicular (Eden's) test is associated with?

Back-packer syndrome

Costoclavicular (Edens) test

Patient seated arms at sides

Bilaterally palpates radial pulse

Extend patients shoulder as patient pulls the shoulders down and backwards and flexes cervical spine

Assess for loss of radial pulse amplitude

Ask for pain

A loss of amplitude with the Costoclavicular (eden`s) test indicates?

Compression of the sublcavian artery between the first rib and clavicle

What is the most common cause for a loss of amplitude with the Costoclavicular (eden`s) test

Old fractured clavicle

What is most likely the most common form of thoracic outlet syndrome

Old fractured clavicle