Adson’s sign or Adson’s maneuver is used to diagnose thoracic outlet syndrome. The clinician has the patient extend their neck and turn their head to the side that is being tested. The patient then holds their breath and the radial pulse is palpated. If the pulse decreases, then vascular compromise is present suggesting thoracic outlet syndrome. Alternatively, auscultation of the subclavian artery can be done. The Adson’s maneuver would cause a subclavian artery bruit to be heard if positive.
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| Thoracic outlet syndrome |
Thoracic outlet syndrome occurs when there is nerve compression at the superior thoracic outlet caused by pressure on a neurovascular bundle that passes between the anterior scalene and middle scalene muscles. There is some degree of variability regarding the number of nerves involved that innervate the upper limb. Arterial circulation can also be compromised in a similar fashion, specifically the subclavian artery and rarely the subclavian vein, which does not normally pass through the scalene hiatus.
Purpose
Adson's test is a provocative test for Thoracic Outlet Syndrome accompanied by compression of the Subclavian artery by a cervical rib or tightened anterior and middle scalene muscles.
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| Adsons Test |
Technique
Starting Position
The test can be performed with the patient in either sitting or standing with their elbow in full extension
Procedure
• The arm of the standing (or seated) patient is abducted 30 degrees at the shoulder and maximally extended.
• The radial pulse is palpated and the examiner grasps the patient's wrist.
• The patient then extends the neck and turns the head toward the symptomatic shoulder and is asked to take a deep breath and hold it.
• The quality of the radial pulse is evaluated in comparison to the pulse taken while the arm is resting at the patient's side.
• Some clinicians have patients turn their head away from the side tested in a modified test.
Positive Test
• The test is positive if there is a marked decrease, or disappearance, of the radial pulse. It is important to check the patient's radial pulse on the other arm to recognize the patient's normal pulse.
• A positive test should be compared with the non-symptomatic side.
