C&T Special Tests

• Special Tests:

  • Cervical Arterial Dysfunction:
  • positional test
  • Thoracic Outlet Syndrome:
  • Adsons
  • Roos test
• Cervical Arterial Dysfunction - Positional Test:

  • performed in sitting
  • rotation of cervical spine to one side for 10 seconds
  • back to neutral for 10 seconds
  • extension of cervical spine for 10 seconds
  • back to neutral for 10 seconds
  • rotation to other side for 10 seconds
  • look in pts eyes throughout and monitor for any symptoms - LOOK FOR 5 D'S AND 3 N'S
• Thoracic Outlet Syndrome:

  • indicated in pts who present with changes to sensation, paraesthesia, burning, coldness, muscular weakness or proprioceptive (loss of coordination and awareness)
  • we also need to distinguish this and a purely nerve involvement problem that is peripheral or nerve root based
  • Need to do an upper limb provocation tests in addition to TOS specific tests:
  • Adsons
  • Roos tests
  • Combining the TOS tests increases specificity to 82%
  • all 3 tests are required to be positive in all types of TOS: venous, arterial and neurogenic
• Thoracic Outlet Syndrome - Adsons Manoeuvre:

  • pts start position:
  • pts sitting, stand behind pts towards the side youre testing
  • actions:
  • palpate pts radial pulse and place arm in slight abduction and lateral rotation
  • ask pts to rotate head toward symptomatic side and extend their neck
  • ask pts to take a deep breath in and hold it
  • normal/abnormal findings
  • disappearance of the pulse indicates a positive test
  • compare the other side as a false positive are common
• Thoracic Outlet Syndrome - Roos test:

  • pts start position:
  • pts sitting, have them abduct both shoulders to 90 degrees and in lateral rotation with elbows at 90 degrees
  • actions:
  • tell pts to repeatedly open and close their fingers for 3 minutes
  • the abducted position narrows the scalene triangle and the repeated opening and closing results in a reduction in radial pulse movement
  • normal/abnormal findings
  • fatigue cramping or tingling on the affected side is a positive test, test also positive if theres any peripheral nerve involvement such as carpal tunnel
  • normal: no issues
• Thoracic Outlet Syndrome - Roos test:

  • a true positive Roos test will have symptoms such as pain/fatigue come on within a minute