Wright's test

Wright's Test is a clinical procedure used in the diagnosis of Thoracic Outlet Syndrome (TOS), a condition characterized by the compression of the neurovascular bundle near the shoulder, leading to symptoms in the neck, shoulder, arm, and hand. This test specifically evaluates for the vascular component of TOS, focusing on the compression of the subclavian artery and vein as well as the brachial plexus.

Procedure

Wright's Test is performed with the patient in a seated or standing position. The examiner palpates the radial pulse of the patient while moving the patient's arm in a slow, controlled manner. Initially, the arm is passively abducted (moved away from the midline of the body) and externally rotated. The patient is then asked to breathe deeply while the examiner monitors for any changes in the strength or quality of the radial pulse. A decrease or absence of the pulse suggests compression of the subclavian artery, indicative of Thoracic Outlet Syndrome.

Interpretation

A positive Wright's Test is indicated by a diminished or absent radial pulse during the maneuver. This suggests that there is vascular compression within the thoracic outlet, which could be due to various anatomical abnormalities such as a cervical rib, hypertrophied scalene muscles, or abnormal fibrous bands. However, it is important to note that a positive test alone does not confirm the diagnosis of TOS. It should be considered in conjunction with patient history, symptoms, and other diagnostic tests.

Differential Diagnosis

When performing Wright's Test, it is crucial to consider other conditions that may mimic Thoracic Outlet Syndrome, including:

• Cervical Radiculopathy
• Peripheral Neuropathy
• Rotator Cuff Injuries
• Carpal Tunnel Syndrome

Limitations

Wright's Test, while useful, has its limitations. The sensitivity and specificity of the test can vary, and false positives can occur. The test's outcome can be influenced by the examiner's technique, the patient's response to pain, and the presence of other underlying conditions.

Related Tests

Other tests used in conjunction with Wright's Test to diagnose Thoracic Outlet Syndrome include:

• Adson's Test
• Roos Test (also known as the Elevated Arm Stress Test)
• Halstead Maneuver

Conclusion

Wright's Test is a valuable clinical tool in the assessment of Thoracic Outlet Syndrome, particularly its vascular component. However, a comprehensive evaluation including a detailed patient history, physical examination, and possibly imaging studies is essential for an accurate diagnosis.