Modified upper limb tension test (Elvey test). This test has a high negative predictive value for nTOS if the patient is able to perform the maneuver for 3 minutes. The patient is asked to open and close the hands for 3 minutes or until pain/paresthesia sets in and the patient is unable to continue. The patient is seated with arms abducted at 90 degrees in external rotation, with elbows flexed to 90 degrees and the head in neutral position. A positive test results in reduction in the amplitude or complete obliteration of the radial pulse.Įlevated arm stress test (EAST or Roos test). The patient is then asked to rotate and laterally flex the neck to the ipsilateral side while inhaling deeply. The examiner palpates the radial pulse and then moves the patient's upper extremity into an extended, abducted, and externally rotated position. The three notable provocative maneuvers that should be executed and documented in patients with TOS, particularly nTOS, are as follows:Īdson test. In addition to tenderness over the scalene muscles and reduced sensation to very light touch in the fingers, an examination for nTOS should include eliciting symptoms by a variety of provocative maneuvers. The standard neurologic examination often fails to detect nTOS.
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