Last reviewed: November 2017
Last updated: August  2016

Summary

Definition

History and exam

Key diagnostic factors

  • hx of repetitive jobs or overhead hobbies/activities
  • pain in upper extremity and adjacent areas
  • paresthesias in arms, hands, and/or fingers
  • circulatory changes in upper extremity
  • upper extremity fatigue

Other diagnostic factors

  • hx of clavicular fracture
  • hx of cardiovascular or thoracic surgery
  • palpation of cervical rib
  • subcutaneous venous collateral around shoulders (Urschel sign)
  • motor weakness
  • hyperhidrosis
  • thenar eminence muscle atrophy
  • exertional pain/claudication
  • supraclavicular systolic bruit
  • blood pressure difference between extremities
  • positive Adson (scalene) test
  • positive costoclavicular test
  • positive hyperabduction test
  • positive Roos test
  • positive stretch test
  • positive upper limb tension tests
  • positive Wright maneuver
  • edema/swelling of upper extremity

Risk factors

  • cervical rib or bony abnormalities
  • trauma
  • poor posture
  • repetitive overhead activity
  • motor vehicle collisions
  • large breasts or implants
  • obesity
  • age (late teens to 60 years)
  • female gender
  • hx of poliomyelitis
  • pregnancy
  • median sternotomy

Diagnostic investigations

1st investigations to order

  • cervical spine x-ray
  • CXR
  • EMG/nerve conduction velocity
  • CT angiography
  • Doppler ultrasonography
Full details

Investigations to consider

  • MRI neck/clavicle/shoulder
  • muscle block
  • conventional arteriography
  • magnetic resonance angiography (MRA)
  • contrast venography
  • magnetic resonance venography (MRV)
  • CBC and coagulation studies
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Sports Medicine Fellow

Christiana Care Health Services

Department of Family and Community Medicine

Wilmington

DE

Disclosures

CS is the author of a reference cited in this monograph.

Assistant Professor

Thomas Jefferson University Hospital

Sports Medicine Specialist

Rothman Orthopaedic Institute

Philadelphia

PA

Disclosures

​PCV ​is the author of a reference cited in this monograph.

Associate Professor

Department of Family and Community Medicine

Jefferson Medical College

Thomas Jefferson University

Philadelphia

PA

Disclosures

​MIH is the author of a reference cited in this monograph.

Associate Professor

Orthopaedic Surgery

Jefferson Medical College

Chief

Division of Hand Surgery

The Rothman Institute

Philadelphia

PA

Disclosures

​PKB ​has stock ownership in Wright Medical Inc.

Dr Chaney Stewman, Dr Peter C. Vitanzo, Dr Marc I. Harwood, and Dr Pedro K. Beredjiklian would like to gratefully acknowledge Dr Harold C. Urschel Jr, Rachel Montano, and Brenda Knee, previous contributors to this monograph. HCU is an author of several references cited in this monograph. RM and BK declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Vascular Surgery

St. George's NHS Healthcare Trust

London

UK

Disclosures

IL declares that he has no competing interests.

Assistant Professor

University of Colorado School of Medicine

Aurora

CO

Disclosures

SRL is the author of a reference cited in this monograph.

Chief

Cardiothoracic Surgery

University of Virginia School of Medicine

Charlottesville

VA

Disclosures

JAK declares that he has no competing interests.

Use of this content is subject to our disclaimer