Hi, my name is Dr. Sannen. I'm an allergy immunology fellow at University Hospitals. Today I'm going to be demonstrating thoracic outlet syndrome. How many of you have you seen a patient with thoracic outlet syndrome in the hospital? And no one? Okay, well, that's why you're here. And we're going to work through the process of when and why you would do the testing for thoracic outlet syndrome. So the thoracic outlet is really important because it's where the neurovascular bundle traverses, so it's in between the scalenes and the subclavian artery. So oftentimes patients will experience paresthesias, numbness, or sometimes even pain that's radiating from the thoracic outlet down to their upper extremity. So there are several maneuvers to test for thoracic outlet syndrome, and they're both called Adson's Maneuver. There's just part one, there's two of those that I will show. Are we ready to get started? Okay. So here what I'm going to do is I'm going to take your left arm and feel for your radial pulse. So I feel it. So the first maneuver I'm going to ask, I'm going to abduct, extend, and externally rotate the arm. In the first maneuver, the patient will look towards me. Can you look towards me and extend your chest out? Good. Take a deep breath in and hold it. I still feel his pulse. How are you feeling? Good. Do you have any numbness or tingling? No. No. Okay. So I'm bringing him back. So that's the first Adson's Maneuver. Do you have any questions? No? Okay. Just a little pop quiz. So what symptoms are you asking the patient about when you're concerned about thoracic outlet syndrome? Numbness and tingling. Okay. Good. All right. So the next maneuver is going to be, again, I'm going to feel for your radial pulse. Lift your arm up, please. And I'm going to abduct, extend, and externally rotate your arm. But this time, I'm going to have you look away and extend your chest out. Breathe in. Hold it. Again, I assess. Do you have any numbness? Any tingling? Any pain? Okay. So his pulse is still strong and bounding. So I will put him back in neutral position. You can come back. Do you all have any questions? Okay. So this was the second Adson's Maneuver. So in summary, the Adson Maneuver, both of them are used to evaluate thoracic outlet syndrome, which is a common condition that you may see in a hospital setting or even in the outpatient setting. So having the ability to do Adson's Maneuver right there and then will help you, in addition to other tests, medical tests, to distinguish if this patient truly has thoracic outlet syndrome. So you will always keep that in the differential in your mind when someone comes in with some kind of paresthesia or numbness in their upper extremities. Okay? Thank you. Okay. Good job. So let's get some feedback from the students and tell me what you think. So why don't you grab the microphone and anybody want to make a comment about what you saw there? Yeah. I thought it was really good. I liked the eye-to-eye contact. I liked the interaction with all of us, kept us engaged, you know, very informative, knowledgeable, and yeah, I thought it was really good. Thank you. I thought it was really good, too. I liked how you spoke slowly and clearly. It didn't seem rushed or nervous. So it was easy to understand you and follow what you were saying. Thank you. I agree with what they said and I liked the detail as well as the audience participation. Okay. So how do you think you did? Well, I think it was very fluid. What did you do right? I was very articulate and very clear and I explained the reason why we're doing the technique and then I demonstrated the techniques and then summarized it at the end. I also tried to keep my audience involved. I do think that I could have been a little bit more clear in differentiating both techniques in the way I explained it. How would you have changed that? I think it was just like a little bit of wording, like just being very clear, you know, the thoracic outlet is surrounded by the subclavian artery and the scalene, so you're compressing the neurovascular bundle, which is the brachial plexus essentially. So it's usually, you know, the radial median and ulnar nerves and just explaining that in a little bit more detail. As medical students, that's what you remember. You have to memorize this brachial plexus. So then when you think brachial plexus, you'll think thoracic outlet syndrome next time as something on your differential. So why are you doing this? So you're trying to basically mimic or recreate a thoracic outlet syndrome because you're compressing the bundle. If I were a student, I would ask that question. Why don't you put the arm this way instead of this way? I think that's the best way to compress the bundle. Yeah, that was, in my opinion, that would have been helpful for a student to say, the more you pull the arm back like this, the more chance you have of compressing and narrowing that outlet. So that's something to consider the next time you teach that. The only other comment I have, that's very minor because most of the students have had anatomy and they understand and they get it. The other one is this is actually a screening test for thoracic outlet syndrome. Most people don't have it, but it's a good screening test to use. Your verbiage in your talk was that this is what you do for thoracic outlet syndrome. You don't have the diagnosis yet. In fact, what you're trying to do is screen for it. So that's good. Overall, I thought it was excellent. Very good positive feedback from your students. You had all the four elements of what you were trying to do. And ultimately, I think the students got the message. So, success. Very good. I'm glad. Thank you guys. Okay.

Adson's Maneuver

thoracic outlet syndrome

neurovascular compression

diagnostic technique

teaching session