Plewa M C, Delinger M
St. Vincent Mercy Medical Center, Department of Surgery, Medical College of Ohio, Toledo 43608, USA.
Acad Emerg Med. 1998 Apr;5(4):337-42. doi: 10.1111/j.1553-2712.1998.tb02716.x.
To estimate the incidence of false-positive findings of thoracic outlet syndrome (TOS) shoulder maneuvers, Adson's test (AT), costoclavicular maneuver (CCM), elevated arm stress test (EAST), and supraclavicular pressure (SCP) in healthy subjects.
A cross-sectional, observational study was performed in a medical school and affiliated emergency medicine residency program setting. Participants included healthy adult volunteers without symptoms of TOS. The shoulder maneuvers AT, CCM, EAST, and SCP were performed in randomized order for 30 sec, 30 sec, 3 min, and 30 sec, respectively. Pulse quality and the presence and timing of pain or paresthesias were assessed.
53 subjects were enrolled, including 27 women, aged 29.7 +/- 6.4 years (range 21-58 years). AT, CCM, EAST, and SCP resulted in an altered pulse in 11%, 11%, 62%, and 21%; pain in 0%, 0%, 21%, and 2%; and paresthesias in 11%, 15%, 36%, and 15% of cases, respectively. The following outcomes had reasonable false-positive rates (upper 95% confidence limit): pain with the AT (7%), CCM (7%), SCP (10%), or any 2 TOS shoulder maneuvers (10%); discontinuing the EAST because of symptoms (16%); or any symptom with 3 (13%) or 4 (7%) TOS shoulder maneuvers.
In a study of TOS shoulder maneuvers in healthy subjects, the outcomes of pulse alteration or paresthesias were unreliable in general. However, TOS shoulder maneuvers have reasonably low false-positive rates when a positive outcome is defined as pain after AT, CCM, or SCP; discontinuation of the EAST secondary to pain; pain in the same arm with > or =2 maneuvers; or any symptom in the same arm with > or =3 maneuvers.
评估胸廓出口综合征（TOS）肩部手法检查、阿德森试验（AT）、肋锁试验（CCM）、抬臂压力试验（EAST）和锁骨上压迫试验（SCP）在健康受试者中出现假阳性结果的发生率。
在一所医学院及其附属急诊医学住院医师培训项目中进行了一项横断面观察性研究。参与者包括无TOS症状的健康成年志愿者。肩部手法检查AT、CCM、EAST和SCP按随机顺序分别进行30秒、30秒、3分钟和30秒。评估脉搏质量以及疼痛或感觉异常的存在情况和发生时间。
共纳入53名受试者，其中27名女性，年龄为29.7±6.4岁（范围21 - 58岁）。AT、CCM、EAST和SCP导致脉搏改变的比例分别为11%、11%、62%和21%；疼痛比例分别为0%、0%、21%和2%；感觉异常比例分别为11%、15%、36%和15%。以下结果具有合理的假阳性率（95%置信上限）：AT引发疼痛（7%）、CCM引发疼痛（7%）、SCP引发疼痛（10%）或任何两项TOS肩部手法检查引发疼痛（10%）；因症状而中断EAST（16%）；或三项（13%）或四项（7%）TOS肩部手法检查出现任何症状。
在一项针对健康受试者的TOS肩部手法检查研究中，脉搏改变或感觉异常的结果总体上不可靠。然而，当阳性结果定义为AT、CCM或SCP后出现疼痛；因疼痛而中断EAST；同一手臂两项及以上手法检查出现疼痛；或同一手臂三项及以上手法检查出现任何症状时，TOS肩部手法检查的假阳性率相当低。
