THE RELIABILITY OF THE DIAGNOSIS OF THORACIC OUTLET SYNDROME

Atrium

Objective. This study assessed the reliability of the special tests used to diagnose thoracic outlet syndrome (TOS) by comparing them with Doppler ultrasound (US). Background. TOS refers to a condition of obstruction of the subclavian vessels and brachial plexus. This results in a classic presentation of numbness and weakness in the upper extremity (UE). The underlying cause of compression due can be identified clinically with 3 special tests. Using US, blood flow velocity changes, alludes to the subclavian artery being narrowed. Methods. 31 participants were entered into the study. They had the three special tests performed on them, while a sonographer concurrently used US to evaluate blood flow velocity through the subclavian artery. Results. Left Adson's exhibited 42% agreement with Doppler. Right Adson's test depicted slightly better agreement at a 52% agreement with a Kappa coefficient of 0.064. Left Halstead's test demonstrated a 48% agreement and a Kappa of 0.053. Halstead's test on the right UE rated 42% in agreement with a Kappa of -0.029. Left Wright's test exhibited 32% agreement with a Kappa of -0.254. Right Wright's test performed the best at a 68% agreement with Kappa at 0.23. Conclusion. The special tests utilized in clinical practice to diagnose TOS demonstrate poor reliability when compared to blood velocity changes on US. It may be that the condition of TOS, since symptoms and compression can be intermittent and related to poor posture, does not compress on the subclavian artery enough to actually alter the pulse intensity unless in severe cases. Grants. President's Faculty Research and Development Grant 2011-2012