The physical examination is one of the most critical aspects of diagnosing Thoracic Outlet Syndrome. Your TOS experienced physician may begin the examination by taking a very detailed and often lengthy history. This is a very important part of the TOS diagnostic puzzle. Here are some important things you should be prepared to answer during this initial history taking phase:
- When did you first notice your symptoms? After an injury? A gradual onset?
- How long have you been experiences these symptoms?
- What makes your symptoms worse?
- Does anything relieve your symptoms temporarily?
- What type of treatment have you had? Physical Therapy, Pain Management, Surgery...
- Do your symptoms interfere with your daily living activities? Brushing hair, getting dressed...
- Do your symptoms interfere with your ability to work?
You will be asked many more questions but these are the basics that all TOS experienced physicians will ask.
Initially, you may be asked to remove your shirt so that the physician can get an overall view of your chest, neck, shoulder, arm and hand. Your physician will then assess circulation and look for any swelling. Your doctor may also check your nailbeds to assess adequate perfusion (capillary refill). If your physician suspects that you may have a vascular problem additional vascular tests may be ordered.
Your posture may be noted and your physician may ask you to "sit up" or pull your shoulders back to see if there is an improvement in symptoms. Pay close attention to your symptoms after you've corrected your posture and report exactly what you feel. (improved, no change, worse...)
You may be asked to perform some simple arm tests that have been used in the past as a diagnostic tool. Arm tests do not completely rule in or out Thoracic Outlet Syndrome. They are a very small part of your exam. Most TOS experienced physicians give little weight to a "positive" arm test without further diagnostic studies. During these arm tests it is important for you to pay close attention to your symptoms and report exactly what you feel.
Your physician may perform additional tests during the intial exam and may order additional diagnostic tests to aid in making a diagnosis. Some tests your physician may order are MRI, CT, EMG, and ultrasound.
If you do have TOS, your physician may order physical therapy for a specific time, lifestyle and work modifications, and possibly surgery. Surgery may be offered initially if you are experiencing life or limb threatening vascular complications.