Home/Education/Clinical tools

Clinical tools

Three instruments used every day in thoracic outlet syndrome clinics, ready to use at the bedside: the QuickDASH disability score, the SVS reporting-standard criteria for neurogenic TOS, and a timer for the elevated arm stress test.

QuickDASH SVS criteria for NTOS EAST / Roos timer

For clinicians

These tools support, and do not replace, clinical judgement. Nothing entered on this page is sent or stored — results stay in this browser tab until you copy or print them. Patients looking for help describing their symptoms can use the symptom self-check instead.

Patient-reported outcome

QuickDASH

The eleven-item short form of the Disabilities of the Arm, Shoulder and Hand questionnaire, the outcome measure most widely reported in TOS studies. The patient rates their ability to do each activity in the last week. A score can be calculated when at least ten of the eleven items are answered.

Diagnosis & reporting

SVS reporting-standard criteria for neurogenic TOS

The Society for Vascular Surgery reporting standards propose that a clinical diagnosis of neurogenic TOS be made when at least three of the four criteria below are met. Using the same definition is what allows results from different centers to be compared.

Tick each criterion that is met Local findings at the thoracic outlet — pain or tenderness over the scalene triangle and/or the pectoralis minor insertion, often with neck, trapezius or chest-wall pain. Peripheral findings of brachial plexus compression — arm or hand pain, paraesthesia or weakness, typically worse with the arm elevated, and reproduced by palpation at the outlet or by provocative manoeuvres (for example EAST or the upper-limb tension test). No other condition better explains the symptoms — cervical spine disease, peripheral nerve entrapment (carpal or cubital tunnel), shoulder pathology and complex regional pain syndrome considered and excluded or judged not to account for the picture. Positive response to a scalene muscle test injection — temporary, clear improvement after a properly performed, image-guided local anaesthetic injection into the anterior (± middle) scalene or pectoralis minor.

0 / 4 criteria met.

Summarised from Illig KA, Donahue D, Duncan A, et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg 2016;64(3):e23–e35. Consult the original publication for the full definitions.

Provocative test

Elevated arm stress test (EAST / Roos test)

The patient sits with both arms abducted to 90° and externally rotated, elbows flexed to 90°, shoulders slightly braced back. They slowly open and close their hands for up to three minutes. Record the time at which their usual symptoms are reproduced, or if they drop their arms.

A positive test is the reproduction of the patient’s own symptoms. It is sensitive but not specific: many people without TOS find it uncomfortable, so it is interpreted together with the rest of the assessment.

3:00

Ready. Press start when the arms are in position.

More from the library

Imaging protocols, diagnostic algorithms and validated outcome measures in full are in the Resources section, and the collaborative’s position on diagnosis is set out in Guidelines & Consensus.