Learning outcome
- Clinical characteristics; pain, weakness, numbness, or paresthesia in the arm
- Causal factors; Compression of the a./v. subclavia, a./v. axillaris, or brachial plexus due to
- Narrowing under a cervical rib
- Narrowing in the scalene outlet (anterior scalene syndrome)
- Narrowing between the clavicle and 1st rib (costoclavicular syndrome)
- Narrowing under the pectoralis minor muscle
Special tests
- Adson’s test
- Wright’s hyperabduction test
- Roos test
Case 1
You work as a junior doctor (LIS1) at a general practitioner office. The next patient is a 50-year-old man. He works as a plumber. For several years he has been troubled with pain in the neck and shoulder area. Previous X-rays have shown degenerative changes in the neck and narrow nerve root canals for the C6 nerve root bilaterally. He now comes with a feeling of weakness in both hands, slightly swollen bluish-red fingers, and blanching of the fingers when using his hands.
- Explain how you can conduct an examination with regard to TOS
Examination
- Conduct a standard neck examination
- Conduct key examinations for radiculopathy C5-Th1
- Perform TOS tests
Clinical findings
On examination, you find no neurological deficits, Spurling test negative, bluish-red color changes in slightly swollen fingers (sausage fingers) and you detect blanching of the fingers on both hands when in use.
Reduced active mobility in the cervical spine, especially for rotation and lateral bending.
Tenderness on palpation of the musculature in M. sternocleidomastoideus, M. trapezius, and in the scalene area.
What is wrong with the patient?
The patient has undergone MRI of the cervical spine and MRI of the thorax. Degenerative disc changes with narrow root canals at C6 bilaterally were detected, no cervical rib, and normal conditions in the scalene area.
The clinical presentation suggests TOS; treatment consists of stretching because the muscles are very tight.