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).