Adson’s test – a provocative test for Thoracic Outlet Syndrome (TOS)

Definition:
Adson’s test/manoeuvre is an orthopaedic examination used to determine the presence of thoracic outlet syndrome in patient.

Test procedure:
The patient’s radial pulse is obtained and retained (palpated), while the patient is instructed to extend their head and rotate it to the ipsilateral side of the arm at which the pulse in being assessed. Following this, the patient is instructed to hold their breath for approximately ten to fifteen seconds.

Test findings:
A loss or significant diminution in the patient’s pulse is interpreted as a positive and may be indicative of thoracic outlet syndrome.

Special considerations:
Adson’s test is now rarely used clinically as it has a high rate of false positives. During this test, symptoms have been reported both to the side of bending and also to the opposite side.
If symptoms present on the side of bending, this presentation is consistent with cervical radiculopathy (Spurling’s sign).