Copyright ©The Author(s) 2021.
World J Clin Cases. Jul 26, 2021; 9(21): 5804-5811
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5804
Table 1 Diagnostic tests for thoracic outlet syndrome
Positive result
Adson maneuverThe affected arm is abducted 30° at the shoulder and maximally extended. The patient extends the neck, turns the head toward the symptomatic shoulder, and inhales deeplyDecrease or absence of ipsilateral radial pulse
Wright maneuverThe shoulder on the symptomatic side is abducted above 90° and externally rotatedDecrease or absence of ipsilateral radial pulse
Halsted maneuverThe affected arm is abducted, extended to 45°, and externally rotated. The examiner applies downward traction to the arm and turns the patient’s neck away from the affected sideDecrease or absence of ipsilateral radial pulse
EAST (Roos test)The arms are placed in the surrender position with shoulders abducted to 90° and in external rotation and the elbows flexed to 90°. The patient slowly opens and closes the hands for 3 minProvoking pain, paresthesia, heaviness, or weakness
ULTT Position 1: Arms abducted to 90° with elbows flexed; Position 2: Active dorsiflexion of both wrists; Position 3: Head is tilted ear to shoulder in both directionsPositions 1 and 2 elicit symptoms on the ipsilateral side, while position 3 elicits symptoms on the contralateral side
Table 2 Differential diagnoses for thoracic outlet syndrome and their distinguishing clinical features
Distinguishing features
Raynaud’s syndromeCold fingers, color changes in the skin in response to cold or stress that are relieved by warmth
VasculitisSevere sudden-onset pain involving more than one limb, elevated C-reactive protein level, skin lesion (e.g., purpura, petechiae, ulcer)
Rotator cuff tearPain during shoulder movement that is easily differentiated by ultrasound
Cervical radiculopathyAcute pain (disc rupture), insidious onset (spinal stenosis), spurling sign (+), denervating potential of cervical paraspinalis on electromyography
Cubital tunnel syndromeTinel sign (+) over cubital tunnel; Differentiated by nerve conduction study
Guyon’s canal syndromeTinel sign (+) over Guyon’s canal; Differentiated by nerve conduction study
Neuralgic amyotrophyExtreme sudden-onset pain followed by rapid motor weakness and atrophy
Pancoast tumorPain in the shoulder radiating to the inner part of the scapula, possible Horner syndrome, tumor on the apex of the lung
Complex regional pain syndromeDiffuse pain, predominant vasomotor features, history of stroke, trauma, or peripheral nerve injury