Neck Orthopaedic Test: Wright Test

The Wright Test is a diagnostic test used in the identification of Thoracic Outlet Syndrome (TOS). The test is also known as the Hyperabduction Test or the Adson's Test. Here is a step-by-step procedure for performing the Wright Test:

1. Explain the procedure to the patient and obtain their consent for the test.
2. Have the patient sit or stand in a comfortable position with their back straight and arms relaxed by their sides.
3. Locate the patient's radial pulse on the affected side (the side with suspected TOS).
4. Instruct the patient to take a deep breath and hold it.
5. Abduct the patient's affected arm to 90 degrees, keeping the elbow straight and the palm facing forward.
6. Extend the patient's arm backward, keeping the palm facing up.
7. Instruct the patient to turn their head toward the affected side and exhale completely.
8. Palpate the patient's radial pulse while rotating and extending the patient's neck and shoulder backward.
9. Observe the patient for any symptoms such as pain, numbness, tingling, or weakness in the hands or arms.
10. Repeat the test on the unaffected side for comparison.
11. If the patient experiences any symptoms, stop the test immediately.
12. Record the results of the test in the patient's medical chart.

A normal result of the Wright Test would be the absence of any symptoms such as pain, numbness, tingling, or weakness in the hands or arms during the test. The sensitivity and specificity of the Wright Test for the diagnosis of Thoracic Outlet Syndrome (TOS) vary widely depending on the study population and diagnostic criteria used.

References:

1. Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome: a review. Neurologist. 2008 Jan;14(1):365-73. doi: 10.1097/NRL.0b013e3181641b31. PMID: 18195648.
2. Machleder HI. Evaluation of thoracic outlet compression syndrome with pulse-volume recordings and duplex scanning. J Vasc Surg. 1992 Oct;16(4):599-605; discussion 605-7. doi: 10.1016/0741-5214(92)90014-d. PMID: 1402176.
3. Povlsen B, Hansson T, Povlsen SD. Thoracic outlet syndrome test: an evaluation of the provocation test in 385 normal individuals. Acta Orthop Scand. 2004 Dec;75(6):722-6. doi: 10.1080/00016470410004257. PMID: 15678922.
4. Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects. J Vasc Surg. 1984 Aug;1(2):351-6. doi: 10.1067/mva.1984.avs0010351. PMID: 6591286.