Which special test for TOS involves neck extension, head rotation toward the affected side, deep breath, and pulse assessment?

• A. Adson maneuver
• B. Wright test
• C. Roos stress test
• D. Eden's test

Answer: (A)

The test focuses on provoking thoracic outlet syndrome by stressing the pathway where the subclavian artery and brachial plexus can be compressed at the thoracic inlet. In the Adson maneuver, the patient extends the neck and turns the head toward the affected side, then takes a deep breath and holds it while the clinician palpates the radial pulse. If the radial pulse diminishes or disappears, it suggests arterial compression at the scalene triangle—typically due to compression by the anterior and middle scalene muscles or a cervical rib. This makes Adson’s maneuver the best choice for assessing arterial TOS in this specific neck-and-breathing–positioning pattern.

The other tests involve different positional stresses: the Wright test uses full arm abduction (often with extension) to compress the costoclavicular space; the Roos stress test requires sustained 90-degree abduction with repeated hand movements to provoke neurovascular symptoms; Eden’s test (costoclavicular maneuver) places the shoulders back and down to stress the costoclavicular space. Each targets a different potential site of compression, which is why they don’t match the described neck extension, head rotation toward the affected side, and deep breath pattern used here.