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Numb & Tingly Fingers May be Thoracic Outlet Syndrome Symptoms

Dr. Z • Mar 28, 2020

How to Test Yourself for Thoracic Outlet Syndrome

If you have thoracic outlet syndrome symptoms (see below), these 5 tests can quickly verify this condition. They're the same tests your doctor uses in the office.


Now you can perform them at home. If you have thoracic outlet syndrome, you should get started on treatment right away in order to keep it from worsening. 

the thoracic outlet

What is thoracic outlet syndrome?

Over 1 in 50 people in the USA have thoracic outlet syndrome. That's about the same prevalence as skin cancer. 


Generally, thoracic outlet syndrome occurs due to compression in the space between your collarbone and first rib. The compression can be on blood vessels or nerves.  


When compression pushes on nerves and blood vessels, you have pain, numbness, weakness and other symptoms. Symptoms can occur anywhere from your fingers to your neck. Often, many patients (and doctors) confuse thoracic outlet syndrome symptoms with those of carpal tunnel syndrome.

shoulder pain

Actually, thoracic outlet syndrome it is not one single disorder. Rather, it's a group of disorders that happen due to compression in the brachial plexus or thoracic outlet. Therefore, you can have one of three types:

 

  • Neurological thoracic outlet syndrome, which is caused by a nerve compression in the brachial plexus.

  • Vascular thoracic outlet syndrome, which has a blood vessel cause.

  • Nonspecific thoracic outlet syndrome, where the cause is unknown.

 

Compression in these areas causes local nerves or blood vessels to compress. As a result, symptoms vary according to which structures are under compression. For example, a compressed nerve results in symptoms that are different than those caused by a compressed blood vessel.

car accident

Usually, physical trauma is the main cause of thoracic outlet syndrome. For instance, it’s common for patients to have it following a car accident, sports injury, repetitive strain injury, and pregnancy. As a matter of fact, many times doctors cannot determine the exact cause of a patient’s thoracic outlet syndrome symptoms whatsoever.


The most common treatment for this condition is physical therapy. In addition, pain relief measures can help ease severe symptoms. Usually, most people will improve using these methods. However, there are cases where doctors recommend surgery to relieve the compression causing it.

pins & needles

Thoracic outlet syndrome symptoms & signs

Thoracic outlet syndrome symptoms due to nerves

Thoracic outlet syndrome symptoms due to compressed nerves (neurological thoracic outlet syndrome) are:

 

Thoracic outlet syndrome symptoms due to blood vessels

Thoracic outlet syndrome due to compressed blood vessels (vascular thoracic outlet syndrome) are:

 

  • Discoloration of your hand (can be bluish in color)
  • Pain or swelling in the arm; can be due to blood clots
  • Blood clot in arteries or veins in your upper body
  • No color in one or more fingers; sometimes the entire hand
  • Weak pulse (or none at all) in the suspected arm
  • Fingers, hands or arms are cold 
  • Your arm fatigues with most activities
  • Fingers are numb or tingly
  • Arm or neck is weak
  • A lump near your collarbone that throbs
pain

5 tests for thoracic outlet syndrome

If you have any of the above thoracic outlet syndrome symptoms, then take the 5 tests below to verify the condition. These are the identical tests for thoracic outlet syndrome that your doctor would perform on you in the office. 


You need a willing partner to help do these tests. Each test aims to reproduce the symptoms by further compressing the brachial plexus or the thoracic outlet. 


For these tests you must:

 

  1. Use a quiet room with no distractions
  2. Get a willing partner
  3. Have a chair without arm rests
  4. Review the instructions & pictures below before attempting the tests

 

If any one of the following 5 tests for thoracic outlet syndrome is positive, it’s likely you have this condition. 


But if they're negative, then you may have carpal tunnel syndrome. In fact, the most common carpal tunnel symptoms are nearly identical to thoracic outlet syndrome symptoms.

Test 1: Elevated arm stress test

elevated arm test for thoracic outlet syndrome

You can sit or stand for this test. First, raise both arms with both elbows slightly behind your head. Next, open and close your hands slowly for 3 minutes. A positive sign for thoracic outlet syndrome is pain, numbness, heaviness or weakness in one or both arms. Also, you may feel tingling in one or both hands.

Test 2: Adson (or scalene) maneuver

Adson test for thoracic outlet syndrome

Stand up and ask you partner for help. Then, the partner must locate the radial pulse in your wrist. You can feel that pulse below the wrist crease and on the thumb side. Next, as the partner feels the pulse, drop your arm downward and out. Now, rotate your head to face the tested arm. Also, at the same time, tilt your head backwards to extend your neck. As the partner is still holding your arm in the extended position, a positive sign is if the pulse disappears.

Test 3: Costo-clavicular maneuver

costo-clavicular test for thoracic outlet syndrome

Sit in a chair and have the partner locate your radial pulse once again. Next, draw your shoulder back and down, while simultaneously lifting your chest. It should feel like you’re exaggerating the “at attention” posture. A positive sign for thoracic outlet syndrome is if the radial pulse disappears.

Test 4: Allen test

Allen test for thoracic outlet syndrome

While seated, the partner locates your radial pulse in your wrist joint again. Then, relax and let the partner extend your arm horizontally and rotated backward. Next, the partner flexes your elbow 90 degrees. Finally, turn your head away from the tested arm. A positive sign for thoracic outlet syndrome is if the pulse disappears as your head rotates.

Test 5: Provocative elevation test

provocative elevation test for thoracic outlet syndrome

Usually, of the 5 tests for thoracic outlet syndrome, doctors perform this as a confirmation when you already have a diagnosis. First, as you remain seated, the partner stands behind you. Next, put your hands on opposite shoulders. Then, the partner grasps both elbows. It’s important to be passive, and allow the partner to fully elevate your shoulders while also bringing the elbow tips together. 

Finally, the partner holds this position for 45 seconds. Usually, doing this increase your pulse rate and your hand’s temperature. However, positive signs for thoracic outlet syndrome are when one or both hands go from numbness to tingling or pins-and-needles (or tingling). Also, there might be some pain. The feeling is similar to having your arm “fall asleep” and then circulation returns. 


In fact, if you have thoracic outlet syndrome symptoms when wearing a heavy coat or backpack, this test will mimic those feelings.

Summary

Doctors use these 5 tests to verify thoracic outlet syndrome symptoms. You can perform these tests on yourself with the help of a partner. The tests can show you if your symptoms of pain, numbness, tingling or weakness are due to this painful condition, or to something else like carpal tunnel syndrome.
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