Adson's Test

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 is an important simple test 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 lessening of the ache or numbness by raising your arm and placing it on your head, for example? That is 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 is not a shoulder condition. In a frozen adhesive capsulitis, for example, raising the upper extremity will certainly increase the symptoms.

But if the tingling is worse when you hang the washing, then there is 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 usually 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

Shoulder abduction relief

The shoulder abduction relief sign is important in ruling out a pinched nerve in the neck; do you have less pain when your arm is above your head?

Thoracic Outlet Syndrome

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. 

Interscalene triangle

Inter scalene triangle

Inter scalene triangle is the space between the first rib and two muscles in the neck; again Adson's test will confirm a problem, with an increase in symptoms when you place your hand on your head.

  • the brachial plexus of five large nerve roots
  • the subclavian artery

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:

  • Does the radial pulse in your wrist stop, or is it greatly reduced, by turning your head to the same side, looking up and simultaneously taking in a deep breath?
  • Does the pulse clearly return when you bring your head back to neutral and breathe out?

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 is 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 Adson's test is usually negative and you do not have a thoracic outlet syndrome.

If both the artery and nerve plexus are 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 does not also address the first rib and scalenes is why surgery and drugs are often not fully successful, if satisfactory at all.

Adson's test

Adson's test is an important part of the examination of tingling in arms and hands.

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 do not have a thrombosis in the arm, then it is 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

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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