THORACIC OUTLET SYNDROME

• Adson Maneuver
• Procedure
• Therapist palpates radial pulse
• Patient rotates head towards the side being tested
and extends the head
• Therapist externally rotates and extends the
patient’s shoulder
• The patient is instructed to take a deep breath and
hold it
• Positive
• Disappearance of the radial pulse

THORACIC OUTLET SYNDROME

• Costoclavicular Syndrome Test
• This test is said to be effective in patient’s who
complain of symptoms as a result of wearing a
back pack or other items putt
• Procedure
• Therapist palpates radial pulse
• Therapist draws the patient’s shoulder down and
back.
• Positive
• Disappearance of the radial pulse

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 THORACIC OUTLET SYNDROME
• Halstead Maneuver
• Procedure
• Therapist palpates radial pulse.
• Therapist applies a downward traction on the tested
arm.
• The patient is instructed to hyperextend and rotate
their neck to the opposite side of the tested arm.
• Positive
• Disappearance of the radial pulse

THORACIC OUTLET SYNDROME

• Wright Test
• Wright suggests the test is used to detect
compression in the costoclavicular space
• Procedure
• Therapist palpates radial pulse
• The therapist externally rotates and elevates the
patient’s arm over their head.
• Having the patient take a deep breath or rotate or
extend their head may have additional effect.
• Positive
• Disappearance of the radial pulse

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 THORACIC OUTLET SYNDROME
• Allen Test
• Procedure
• Therapist palpates radial pulse.
• Therapist places the patient’s arm at 90° shoulder
abduction, shoulder horizontal extension and
external rotation, and 90° elbow flexion.
• The patient is instructed to rotate the head to the
opposite side of the tested arm.
• Positive
• Disappearance of the radial pulse

THORACIC OUTLET SYNDROME

• Roos Test
• Procedure
• Patient is instructed to stand and abduct arms to 90°,
externally rotate shoulder, and flex elbows to 90°.
• The patient is then instructed to open and close their
hands slowly for 3 minutes while maintain the position
of their arms.
• Positive
• Inability to maintain starting position of the arms for 3
minutes
• Ischemic pain, heaviness, or profound weakness of the
arms (minor fatigue and distress is not considered a
positive)
• Numbness and tingling of the hand

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 THORACIC OUTLET SYNDROME
• Shoulder Girdle Passive Elevation Test
• Test is used on patients who present with
symptoms at the time of examination.
• Procedure
• Patient is in sitting
• Therapist passively elevates the patient’s shoulder
girdle up and forward (elevation) and holds the
position for 30 seconds or more.
• Positive
• Decrease in signs and symptoms (release
phenomenon)
• Arterial relief: skin color change, ↑ skin temperature,
stronger pulse
• Venous relief: ↓ cyanosis, ↓ swelling (venous
engorgement)
• Neurological relief: ↓ numbness and ngling, ↓ pain