Wright’s Test | Thoracic Outlet Syndrome Assessment

Thoracic Outlet Syndrome is defined as a neurovascular symptom complex associated with compression of the brachial bundle, which includes the brachial plexus and/or subclavian vessels. This compression may be caused by several anatomical structures in one or more of the following three compartments: the interscalene triangle, the costoclavicular space, or retropectoralis minor space.

The Wright’s test is designed to decrease the retropectoralis minor space in the first step, while the second part of the test implicates the costoclavicular interval.
Unclear descriptions in the performance of the Wright’s test in the study of Gillard et al. in 2001 prohibit any statement about the accuracy of this test. For this reason, the clinical value in practice is questionable.

To perform the test, the patient sits in a comfortable position. For the first part of the test, the patient’s arm is passively brought into abduction and external rotation to 90° without tilting the head. The elbow is flexed no more than 45°. The arm is then held for 1 min. The tester monitors the patient’s symptom onset and the quality of the radial pulse. The test is repeated with extremity in hyperabduction (end range of abduction).

A positive result is a decrease in the radial pulse and/or reproduction of the patient’s symptoms. Be aware, that other authors have described adding on the effect of cervical spine motion like flexion, extension, and left and right rotation.

Other common tests to assess for TOS are:

• Adson Test
• Eden Test
• Cyriax Release Test
• Roos Test / Elevated Arm Stress Test
• Tinel Sign 
• Morley / Brachial Plexus Compression Test
• Costoclavicular / Halstead Maneuver

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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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 Oct 1;68(5):416-24.