Assignment Details

Introduction
Name :
Faizan Ali
Roll No :
[70110611]
Section :
DPT-C
Department :
UIPT-UOL
Subject :
Anatomy - 1
Submitted To :
Dr. Arooj Hanif [PT]
Topic :
Thoracic Outlet Syndrome
[TOS]
 Definition/Description

The term ‘thoracic outlet syndrome’ describes

compression of the neurovascular structures as
they exit through the thoracic outlet
(cervicothoracobrachial region).
The thoracic outlet is marked by the anterior
scalene muscle anteriorly, the middle scalene
posteriorly and the first rib inferiorly.

 Special Physical Tests for Thoracic Outlet

Syndrome (TOS)
  Elevated Arm Stress/ Roos Test:
The patient has
arms at 90° abduction and the therapist puts
downwards pressure on the scapula as the
patient opens and closes the fingers.
If the TOS symptoms are reproduced within 90
seconds, the test is positive.

 Wright’s Test:
The patient’s arm is hyper
abducted.
If there is a decrease or absence of a pulse on
one side then the test is positive, showing the
axillary artery is compressed by the pectoralis
minor muscle or coracoid process due to
stretching of the neurovascular bundle.
  Supraclavicular Pressure Test:
The patient is seated
with the arms at the side.
The examiner places his fingers on the upper
trapezius and thumb on the anterior scalene
muscle near the first rib. Then the examiner
squeezes the fingers and thumb together for 30
seconds.
If there is a reproduction of pain or paresthesia
the test is positive, this addresses compromise
to brachial plexus through scalene triangles.

 Costoclavicular Maneuver Test:

This test may be used for
both neurological and vascular compromise.
The patient brings his shoulders posteriorly and
hyperflexes his chin.
A decrease in symptoms means that the test is
positive and that he neurogenic component of
the neurovascular bundle is compressed.

 Cervical Rotation Lateral Flexion Test:

The test is performed
with the patient in sitting. The cervical spine is
passively and maximally rotated away from the
side being tested.
While maintaining this position, the spine is
gently flexed as far as possible moving the ear
toward the chest.
A test is considered positive when the lateral
flexion movement is blocked.
 Cyriax Release Test :
The patient is seated or standing.
The examiner stands behind patient and grasps
under the forearms, holding the elbows at 80
degrees of flexion with the forearms and wrists
in neutral.
The examiner leans the patient’s trunk
posteriorly and passively elevated the shoulder
girdle. This position is held for up to 3 minutes.

The test is positive when paresthesia and/or

numbness (release phenomenon) occurs,
including reproduction of symptoms

 Adson’s Test for Thoracic Outlet

Syndrome

 Adson’s Test :
Adson’s Test, also known as
Adson’s Maneuver, is a test used in orthopedic
examination of the shoulder when testing for
thoracic outlet syndrome.

Involved Structures
 Subclavian artery
 Anterior scalene
 Middle scalene

 Upper Limb Tension Test :

These tests are
designed to put stress on neurological
structures of upper limb.
The shoulder, elbow, forearm, wrist and
fingers are kept in specific position to put
stress on particular nerve (nerve bias) and
further modification in position of each
joint is done as “sensitizer”.