Adson’s Vascular Test

A special test for Thoracic Outlet Syndrome (TOS)

Authors

Affiliations

Nathaniel Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Warning

This test has some of the best validity out of other TOS tests

But there are some issues:

1. Conflicting evidence on the biomechanical mechanism of the test as seen below
2. The large percent of false positives when using radial pulse as the main outcome measure¹

Adson’s Vascular test is a special test that is designed to rule in a vascular source of thoracic outlet syndrome

Technique

Pt is sitting arms at 15 degrees ABD, PT palpating radial pulse

Conflicting evidence

According to those who proposed the Adson’s Vascular test, this position theoretically tensions anterior and middle scalenes, compromising (compressing) the interscalene triangle².

Contrasting biomechanical evidence finds the scalene angle to increase, which should reduce likelihood of compression²

• Patient asked to inhale and hold breath²
• Patient asked to tilt head back, rotate head so that chin is elevated and pointed to examined side²

Interpretation

• Diminished or occluded radial pulse is considered a positive test

Caution

Using radial pulse to conclude a positive test has been shown to produce many false positives¹

• Parasthesia: Change in parasthesia can be an indication of a positive test
  • There has been no studies performed on the validity of using change in symptoms to rule in TOS using Adson’s Vascular Test.

References

1.

Hooper TL, Denton J, McGalliard MK, Brismée JM, Sizer PS. Thoracic outlet syndrome: A controversial clinical condition. Part 1: Anatomy, and clinical examination/diagnosis. The Journal of Manual & Manipulative Therapy. 2010;18(2):74-83. doi:10.1179/106698110X12640740712734

2.

Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.