Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients

Objective. To evaluate the diagnostic usefulness of provocative tests, Dopp ler ultrasonography, electrophysiological investigations, and helical compu ted tomography (CT) angiography in thoracic outlet syndrome (TOS). Patients and methods. We prospectively evaluated 48 patients with a clinical suspic ion of thoracic outlet syndrome. Standardized provocative tests, an electro myogram and somatosensory evoked responses, a Doppler ultrasonogram, and a helical CT arterial and/or venous angiogram with dynamic maneuvers were don e on each patient. The final diagnosis was established by excluding all oth er causes based on all available data. The agreement between the results of each investigation and the final diagnosis was evaluated. Results. Provoca tive tests had mean sensitivity and specificity values of 72% and 53%, resp ectively, with better values for the Adson test (positive predictive value [PPV], 85%), the hyperabduction test (PPV, 92%), and the Wright test. Using several tests in combination improved specificity. Doppler ultrasonography visualized vascular parietal abnormalities and confirmed the diagnosis in patients with at least five positive provocative tests. Electrophysiologica l studies were useful mainly for the differential diagnosis or for detectin g concomitant abnormalities. Although helical CT angiography provided accur ate information on the location and mechanism of vascular compression, the usefulness of this investigation for establishing the diagnosis of TOS and for obtaining pretherapeutic information remains unclear. Joint Bone Spine 2001; 68 : 416-24. (C) 2001 Editions scientifiques et medicales Elsevier SA S.