Purpose
This test is a diagnostic tool used in the identification of Thoracic Outlet Syndrome (TOS). It is also known as the “elevated arm stress test” or “EAST”.
Clinically Relevant Anatomy
Please refer to the Thoracic Outlet Syndrome (TOS) page.
Technique
Starting postion: [1]
- The patient has both arms in the 90° abduction-external rotation position
- Shoulders and elbows are in the frontal plane of the chest
Execution:
- The patient is to open and close the hands slowly over a 3-minute period
Results if normal:
- Only forearm muscle fatigue and minimal distress
Possible symptoms if TOS is present:
- gradual increase in pain at neck and shoulder, progressing down the arm
- Paraesthesia in forearm and fingers
- In case of arterial compression: arm pallor with arm elevated, reactive hyperemia when limb is lowered
- In case of venous compression: Cyanosis and swelling
- Inability to complete test, and patient drops arms in lap in marked distress, recognized as reproduction of usual symptoms
- Reproduction of the usual symptoms that involve the entire extremity!
Possible results if carpal tunnel syndrome is present:
- Numbness in first three fingers due to compression of nervus medianus
Possible results in case of cervical disc syndrome:
- Pain in neck and shoulder from holding arms elevated but minimal distress in arm or hand.
Possible results in case of orthopedic shoulder problems:
- Intolerable symptoms confined to shoulder area
Diagnostic accuracy:[2]
- Sensitivity: 84%
- Specificity: 30%
- PPV: 68%
- NPV: 50%
Reliability:
- Inter and intra-examiner reliability have not yet been found in the literature.
Key Research
Gillard J, Pérez-Cousin M, Hachulla É, Remy J, Hurtevent JF, Vinckier L, Thévenon A, Duquesnoy B. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine, 2001; 68(5): 416-424.
References
