Wright Test

 Wright Test

What is Wright Test?

Wright Test or Hyperabduction test is used for thoracic outlet syndrome.

With repeated or continuous hyperabduction of the arm , the neurovascular structures in the axilla are stretched under the pectoral minor tendon and the coracoid process, resulting in a neurovascular syndrome.

See Also Brachial Plexus Anatomy

How it’s Performed?

Wright Test
Wright Test

What does a positive Wright Test mean?

Sensitivity & Specificity

No diagnostic accuracy studies have been performed to determine the sensitivity and specificity of this test.

However, is important to note that a number of studies have found that arm elevation induces radial pulse obliteration in 60–69% of normal subjects. 1 + 2

Notes

The following should be considered in the differential diagnosis of the positive wright test:

  1. An infiltrative tumor (such as a Pancoast tumor) growing into the plexus.
  2. A tardive radiation-induced palsy.
  3. A neuroma within the brachial plexus.

Thoracic Outlet Syndrome

The bony boundaries of the outlet include:

  1. The clavicle.
  2. The first rib.
  3. The scapula.

The outlet passage is further defined by the interscalene interval, a triangle with its apex directed superiorly. This triangle is bordered anteriorly by the anterior scalene muscle, posteriorly by the middle scalene muscle, and inferiorly by the first rib.

The lowest trunk of the brachial plexus, which is made up of rami from the C8 and T1 nerve roots, is the most commonly compressed neural structure in TOS

TOS was first noted in 1743 when an association was made between the cervical rib and TOS, although it was not until 1818, that the medical management of TOS was discussed. In the early twentieth century, Adson stressed the role of the scalene muscles in neurovascular compromise, and Wright showed that shoulder hyperabduction could produce thoracic outlet obstruction.

Reference

  1. Gilroy J, Meyer JS: Compression of the subclavian artery as a cause of ischaemic brachial neuropathy. Brain 86:733 746, 1963.
  2. Raaf J: Surgery for cervical rib and scalenus anticus syndrome. J Am Med Assoc 157:219–25, 1955
  3. Wright IS: The neurovascular syndrome produced by hyperabduction of the arms. Am Heart J 29:1–19, 1945.
  4. Clinical Tests for the Musculoskeletal System 3rd Ed. Book.
  5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
  6. Morton, DA, Foreman KB, Albertine KH: The Big Picture: Gross Anatomy, McGraw-Hill, 2011.)

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