Neck Orthopaedic Test: Adsons Test

Adson's test is a clinical test used to evaluate Thoracic Outlet Syndrome (TOS). TOS is a condition that occurs when the blood vessels or nerves in the thoracic outlet, which is the area between the collarbone and the first rib, become compressed or irritated. Adson's test is one of the several diagnostic tests used to identify TOS.

Procedure:

1. Ask the patient to sit down and remove any clothing that may obstruct the neck or shoulder area.
2. Have the patient turn their head to the side being tested (usually the affected side).
3. Palpate the radial pulse on the wrist of the same side being tested.
4. Ask the patient to take a deep breath and hold it.
5. While the patient is holding their breath, gently extend and externally rotate the patient's arm and shoulder, and then ask the patient to take another deep breath and hold it.
6. Ask the patient to rotate their head toward the opposite side.
7. Monitor the radial pulse on the wrist throughout the maneuver.
8. Release the arm and shoulder and let the patient breathe normally.
9. Repeat the procedure for the other side if necessary.
10. Document any changes in the radial pulse and any symptoms experienced by the patient during the test.

A normal result of Adson's test is the presence of a strong radial pulse throughout the maneuver without any significant change. This suggests that there is no compression or obstruction of the blood vessels or nerves in the thoracic outlet.

References:

1. Babinski MA, Babinski ME, Colosimo AJ, Smith RW. The sensitivity and specificity of three clinical provocation tests for thoracic outlet syndrome. Orthopedics. 2002 Sep;25(9):1013-8. doi: 10.3928/0147-7447-20020901-12. PMID: 12269573.
2. Roos DB. Thoracic outlet syndrome is overdiagnosed. Arch Surg. 1988 Mar;123(3): 378-82. doi: 10.1001/archsurg.1988.01400270092017. PMID: 3343023.
3. Sheth RN, Campbell JN. Thoracic outlet syndrome evaluation by means of electrodiagnostic testing. Hand Clin. 2004 Aug;20(3):313-22. doi: 10.1016/j.hcl.2004.03.011. PMID: 15347488.
4. Chandra V, Little C, Lee MJ. Diagnostic Value of Adson's Test and Wright's Test for Thoracic Outlet Syndrome. Ann Vasc Surg. 2015 Jul;29(5):890-4. doi: 10.1016/j.avsg.2014.12.014. Epub 2015 Mar 14. PMID: 25779728.
5. Sunderland S. The tests of brachial plexus irritation. Brain. 1948 Dec;71(4):345-66. doi: 10.1093/brain/71.4.345. PMID: 18103262.
6. Smith RW. The thoracic outlet syndrome. Clin Orthop Relat Res. 1986 Feb;(202):196-204. PMID: 3947438.
7. Rayan GM. Thoracic outlet syndrome. J Shoulder Elbow Surg. 1998 Mar-Apr;7(2): 112-8. doi: 10.1016/s1058-2746(98)90019-7. PMID: 9588131.
8. Adson AW. Surgical treatment for symptoms produced by cervical ribs and the scalene anticus muscle. Ann Surg. 1927 Sep;86(3):430-9. doi: 10.1097/00000658-192709000-00007. PMID: 17865567.