Adson's test is the definitive examination for a thoracic outlet syndrome.
If you are suffering from tingling in the upper limb, more often in one only, then there's an important simple examination that you can do at home. Are the paresthesias, as they are known, relieved or worsened by raising your arm above your head, as in hanging the washing?
Do you get relief by raising your arm and placing it on your head, for example? That's known as the shoulder abduction relief sign.
Then we are probably looking at a nerve root impingement. Perhaps a slipped disc in the cervical spine, or serious degenerative changes of the joints of Luschka in the intervertebral foramen.
Or, is the pain at night relieved by placing your hand under your pillow, or under your head? That takes the traction off the nerve.
This lady had a severe pinched root in her neck from a diving accident. She gets relief by raising her arm.
Is the pain and tingling in arms and hands worsened when raising the limb? Firstly, we have to be sure this isn't a shoulder condition. In a frozen shoulder, for example, raising the upper extremity will certainly increase the symptoms.
But if the tingling is worse when you hang the washing, then there's a good chance that you have something quite different; the thoracic outlet syndrome.
Thoracic outlet syndrome is a condition seemingly far worse but in my experience the correct treatment of TOS is less arduous than a true pinched nerve root.
Two important structures run through the inter scalene triangle; a group of five nerve roots called the brachial plexus, and the artery that supplies the arm.
Shoulder Abduction Relief sign
Thoracic outlet syndrome is caused by interference of the subclavian artery and the brachial plexus as they emerge from behind the collarbone in the upper chest; Adson's test is the classic examination to confirm the condition.
Inter scalene triangle is the space between the first rib and two muscles in the neck.
These structures supply the arm with blood and nerve innervation. In the thoracic outlet syndrome both may be affected resulting in your arm being without blood and nerve supply when you raise your arm above your head. The result is pain and a dead feeling and tingling in arms and hands; actually, usually one side only.
The definitive test for this condition is Adson's test. It's not a test for the lay person to do. In fact, it takes great experience to do it satisfactorily.
Further, I do it in a different way from that normally taught, which gives too many false positives as they are known. Quite normal people often then have a test suggesting there is a problem when there isn't.
We are testing for two things:
The chiropractic management of the thoracic outlet syndrome is dependent on whether there is a fixation of the first rib, or spasm of the two scalene muscles involved. If either, or both, are found then there's a high likelihood that our treatment may be effective in managing the tingling in your arms and hands.
If neither are found, we must look further for other causes of a positive Adson's test.
The pinched nerve root is diagnosed, in part by the upper limb tension test, but then adsons is usually negative and you do not have thoracic outlet syndrome.
If both the artery and nerve plexus are severely affected in the inter scalene triangle then the pain and tingling in the arm may be severe.
More commonly, a mild irritation of one or other is often the underlying cause of the many arm pain syndromes that face chiropractors on a daily basis.
Treatment of these conditions that doesn't also address the first rib and scalenes is why surgery and drugs are often not fully successful, if satisfactory at all.
Adson's test is an important part of the examination of tingling in arms and hands.
Tingling in arms and hands should not be treated lightly. Adson's test is part of the examination.
If your arm swells, or changes colour, then there is immediate concern. A blood clot does not occur frequently like a deep vein thrombosis in the lower leg, but it can and does happen. Get a medical opinion immediately, before anything else.
But sometimes the vein also passes through the inter scalene triangle; once your doctor is sure you don't have a thrombosis in the arm, then it's time to see your chiropractor.
The test may be affected by atherosclerotic changes in the artery. Various toxins from viruses and cigarette smoke may initiate and cause irritation in the intima, or inner lining. Then oxidised fatty acids, such as you may get from deep frying oil that has been repeatedly reheated, is deposited and sets up an inflammatory reaction.
If this is happening in the subclavian artery which Adson's test is examining, then it may produce some bizarre signs.
Fast foods, and particularly deep fried junk like bagels are amongst the number one contenders to the throne; keep them for high and holy days; and maybe not even then.
Useful links @ Adsons test
Interesting questions from readers