Provocative tests in the diagnosis of thoraсic outlet syndrome

Abstract

Objective — to study the reliability, expediency and informational content of provocative tests in the diagnosis of thoraсic outlet syndrome.Methods and subjects. The study involved 82 patients with complaints of pain in the shoulder girdle and/or upper limb. All patients underwent a complex set of examinations, which consisted of radiography and magnetic resonance imaging of the cervical spine, ultrasound diagnostics of the neck soft tissues, shoulder girdle and upper extremity vessels, stimulating electroneuromyography and needle electromyography of upper extremity. In order to identify vessel or nervous fiber involvement we performed provocative tests.Results. After the careful history taking, clinical examination, data of instrumental methods of examination, thoracic outlet syndrome was diagnosed in 23 patients. The sensitivity of the Adson test for TOS was identified in 43 % of patients, the specificity was in 80 %, the sensitivity of the EAST test was in 53 %, and the specificity was in 75 %. Patients with TOS during the EAST test had symptoms of one‑sided type or symptoms were more expressed on a particular side. In addition, in patients with TOS, the numbness in most cases localized on the ulnar edge, whereas in practically healthy individuals it was diffuse. In patients with TOS, numbness was observed after the first minute.Conclusions. The results of Adson and EAST test for the diagnosis of neurogenic TOS should be confirmed by instrumental methods of examination, due to the low sensitivity and specificity of individually applied provocative tests. During the EAST test it is important to pay attention to the time when symptoms occur and which symptoms are present, especially the feeling of numbness and pain with typical for TOS localization, which may be a marker for neurogenic TOS or mixed forms of TOS if signs of vascular component involvement is determined by instrumental examination methods and provocative tests.