Assesses for vascular thoracic outlet syndrome (TOS) at the inter-scalene triangle.

  • Halstead Maneuver
    • “Exaggerated Military Position”

  • When a patient is experiencing symptoms in the neck that radiate to the ipsilateral upper extremity
    • Possible associated symptoms include ipsilateral upper extremity radiation of pain, paresthesia (or other sensory deficit), weakness, cyanosis, or swelling

Patient Position
  • Sitting or standing
Examiner Position
  • Standing behind the patient
Steps of Performance
  1. Examiner contacts and monitors the radial pulse with fingertips throughout the procedure
  2. Examiner externally rotates the extremity, abducts arm to 45 degrees, and extends the shoulder 45 degrees
  3. Downward distraction is applied to the arm throughout the exam
  4. Patient is then asked to rotate head away from the examined arm
Alternative Methods

Halsted Maneuver

  1. Radial pulse is monitored by the examiner throughout the procedure
  2. Patient is seated or standing and actively rolls shoulders backward and downward, narrowing the costoclavicular space
  3. If no symptoms are noted, patient is asked to rotate their head to the contralateral side

Contralateral rotation stretches the brachial plexus and scalene muscles, narrowing the inter-scalene triangle and compressing the neurovascular bundle as it passes through. This stress could compromise vasculature and lead to a decrease or absence of pulse distal to the constricted vessel and/or the recreation of neurologic symptoms along the affected extremity.

General

Positives

Absence/Disappearance of the Radial Pulse

  • Vascular thoracic outlet syndrome

Pertinent Negatives

Parsethesia or Radiating Pain in the Tested Extremity

  • Neurologic thoracic outlet syndrome

DATA
TAGS
References
Halstead Test. Physiopedia. Accessed April 16, 2022.
Thoracic Outlet Compression Syndromes (TOS) - Neurologic Disorders. Merck Manuals Professional Edition. Accessed April 16, 2022.
David J. Magee. Orthopedic Physical Assesment. 6th ed. Elsevier; 2014.
Hixson KM, Horris HB, McLeod TCV, Bacon CEW. The Diagnostic Accuracy of Clinical Diagnostic Tests for Thoracic Outlet Syndrome. J Sport Rehabil. 2017 Sep;26(5):459-465. DOI: 10.1123/jsr.2016-0051
Demirbag D, Unlu E, Ozdemir F, Genchellac H, Temizoz O, Ozdemir H, Demir MK. The relationship between magnetic resonance imaging findings and postural maneuver and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study. Arch Phys Med Rehabil. 2007 Jul;88(7):844-51. DOI: 10.1016/j.apmr.2007.03.015
Nord KM, Kapoor P, Fisher J, et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol . 2008;48(2):67-74.

Assesses for vascular thoracic outlet syndrome (TOS) at the inter-scalene triangle.

  • When a patient is experiencing symptoms in the neck that radiate to the ipsilateral upper extremity
    • Possible associated symptoms include ipsilateral upper extremity radiation of pain, paresthesia (or other sensory deficit), weakness, cyanosis, or swelling

Patient Position
  • Sitting or standing
Examiner Position
  • Standing behind the patient
Steps of Performance
  1. Examiner contacts and monitors the radial pulse with fingertips throughout the procedure
  2. Examiner externally rotates the extremity, abducts arm to 45 degrees, and extends the shoulder 45 degrees
  3. Downward distraction is applied to the arm throughout the exam
  4. Patient is then asked to rotate head away from the examined arm
Alternative Methods

Halsted Maneuver

  1. Radial pulse is monitored by the examiner throughout the procedure
  2. Patient is seated or standing and actively rolls shoulders backward and downward, narrowing the costoclavicular space
  3. If no symptoms are noted, patient is asked to rotate their head to the contralateral side

Contralateral rotation stretches the brachial plexus and scalene muscles, narrowing the inter-scalene triangle and compressing the neurovascular bundle as it passes through. This stress could compromise vasculature and lead to a decrease or absence of pulse distal to the constricted vessel and/or the recreation of neurologic symptoms along the affected extremity.

General

Positives

Absence/Disappearance of the Radial Pulse

  • Vascular thoracic outlet syndrome

Pertinent Negatives

Parsethesia or Radiating Pain in the Tested Extremity

  • Neurologic thoracic outlet syndrome