Cervical Rib (Thoracic Outlet Syndrome)

Look

  1. Scar over clavicle or supra-clavicular fossa:
    • Check for surgical scars or other abnormalities.
  2. Mass in the supra-clavicular region:
    • Note any swelling or palpable masses.
  3. Asymmetry in size of limbs:
    • Compare the size of the affected limb with the unaffected one.
  4. Venous distension of chest wall:
    • Observe for prominent veins on the chest wall.

Hands

  1. Wasting of small muscles in the hand:
    • Check for atrophy of the thenar and hypothenar muscles.
  2. Trophic changes in fingers:
    • Look for changes in skin texture, sweating, nail appearance, or color.

Feel

  1. Temperature difference in hands:
    • Assess for temperature differences between the affected and unaffected hand.
  2. Sensation:
    • Evaluate dermatomes and peripheral nerves, focusing on the medial forearm and arm to differentiate from the ulnar nerve.
    • Test sensation in the hands, especially around the brachial plexus.

Move

  1. Roo’s Test (Neurologic):
    • Ask the patient to brace their shoulders back and fully flex elbows.
    • Have them rapidly flex and extend fingers.
    • Positive result if neurologic symptoms (numbness, tingling, weakness) are reproduced.
  2. Adson’s Test (Vascular):
    • Extend the head and rotate it to the affected side (similar to Spurlings test).
    • Abduct the arm to 30 degrees with the elbow straight.
    • Feel for the radial pulse on the same side.
    • Take a deep breath in.
    • Positive if there is an alteration in the quality of the pulse (e.g., disappearance or weakening of the pulse).
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