Vascular compression in the thoracic outlet. Age dependent normative values in noninvasive testing

Abstract

Thoracic outlet syndromes are the result of vascular and/or nerve compression. In order to diagnose these syndromes careful clinical examination and objective testing are required. Vascular compression can be provoked by three well-defined thoracic outlet compression manoeuvres. Changes in vascular pulsation during these manoeuvres can be registered by means of plethysmography of the fingers. For an adequate interpretation of the clinical value of the various techniques of provoking vascular compression, a knowledge is required of the frequency with which vascular compression can be provoked in normal subjects of different age groups. We measured the changes in pulse in normal volunteers in 5-year age groups ranging from 15 to 85. This study showed that vascular compression until zero flow during 120 degrees arm abduction seems to be normal rather than abnormal. Zero flow during Adson manoeuvre and military attitude did not occur frequently in the supine position in normal subjects. Neither the different age groups nor the sexes showed any real differences in the quality of the findings. Therefore, establishing zero flow by means of a costoclavicular compression or scalenic compression is a clinically significant finding, while zero flow during 120 degrees abduction (pectoralis minor compression) is within normal limits.