Orthopedic Exam / Special Tests for Physical Therapy: SHOULDER
Thoracic Outlet Syndrome (TOS)
Thoracic Outlet Syndrome involves the compression at the superior thoracic outlet, resulting from excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles. TOS can also affect one or more of the nerves or blood vessels as they pass between the chest and upper extremity.
Thoracic Outlet Syndrome symptoms include arm, shoulder, and/ or neck pain, numbness in the fingers, hand and/or arms, weakness and impaired circulation to the upper extremities.
The anterior scalene muscle lies deeply at the side of the neck, behind the SCM. It arises from the anterior tubercles of the transverse processes of the C3, C4, C5 and C6 cervical vertebrae, and descends, almost vertically. It inserts into the scalene tubercle on the inner border of the first rib, and into the ridge on the upper surface of the
rib in front of the subclavian groove. The anterior scalene can be involved in certain forms of thoracic outlet syndrome as well as myofascial pain syndrome, the symptoms of which may mimic a spinal disc herniation of the cervical vertebrae.
Special Test: Adson’s Test:
- Testing for: Neurovascular Compression (TOS) caused by the Anterior Scalene.
Video Demo Instructions, Procedure, Positive Test:
Special Test: Adson’s Test: Video Demo (Procedure below)
ADSON’S TEST: Procedure:
• Patient is seated.
• Therapist passively extends and slightly
externally rotates patient’s affected arm
• Therapist monitors patient’s radial pulse
• Patient rotates their head towards the affected side, then slightly elevates
• Patient takes a deep breath and holds it for 15-30
ADSON’S TEST: Positive Sign:
- Patient’s symptoms reoccur (numbness, tingling in hands and fingers) or the patient’s radial pulse diminishes.