Essentials of thoracic outlet syndrome: A narrative review

Table 1 Diagnostic tests for thoracic outlet syndrome

Test	Maneuver	Positive result
Adson maneuver	The 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 deeply	Decrease or absence of ipsilateral radial pulse
Wright maneuver	The shoulder on the symptomatic side is abducted above 90° and externally rotated	Decrease or absence of ipsilateral radial pulse
Halsted maneuver	The 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 side	Decrease 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 min	Provoking 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 directions	Positions 1 and 2 elicit symptoms on the ipsilateral side, while position 3 elicits symptoms on the contralateral side

EAST: Elevated arm stress test; ULTT: Upper limb tension test.

Table 2 Differential diagnoses for thoracic outlet syndrome and their distinguishing clinical features

Disorder	Distinguishing features
Raynaud’s syndrome	Cold fingers, color changes in the skin in response to cold or stress that are relieved by warmth
Vasculitis	Severe sudden-onset pain involving more than one limb, elevated C-reactive protein level, skin lesion (e.g., purpura, petechiae, ulcer)
Rotator cuff tear	Pain during shoulder movement that is easily differentiated by ultrasound
Cervical radiculopathy	Acute pain (disc rupture), insidious onset (spinal stenosis), spurling sign (+), denervating potential of cervical paraspinalis on electromyography
Cubital tunnel syndrome	Tinel sign (+) over cubital tunnel; Differentiated by nerve conduction study
Guyon’s canal syndrome	Tinel sign (+) over Guyon’s canal; Differentiated by nerve conduction study
Neuralgic amyotrophy	Extreme sudden-onset pain followed by rapid motor weakness and atrophy
Pancoast tumor	Pain in the shoulder radiating to the inner part of the scapula, possible Horner syndrome, tumor on the apex of the lung
Complex regional pain syndrome	Diffuse pain, predominant vasomotor features, history of stroke, trauma, or peripheral nerve injury