Which test is NOT a standard provocative maneuver for TOS evaluation?

• A. ROOS test
• B. Supraclavicular pressure test
• C. Wright hyperabduction test
• D. Spurling test

Answer: (D)

The tests are all used to provoke symptoms from compression at the thoracic outlet, testing the neurovascular bundle as it passes between the neck and arm. Spurling test, on the other hand, targets the cervical nerve roots by extending and side-bending the neck and applying axial pressure to reproduce radicular pain from cervical radiculopathy. Because the goal here is to assess compression at the thoracic outlet rather than the cervical spine, Spurling test isn’t a standard provocative maneuver for TOS evaluation. The other maneuvers—Roos test with the arms held in a high, external rotation position and repeated opening/closing of the hands; the Wright hyperabduction test with the arm abducted and extended to provoke compression beneath the pectoralis minor or at the costoclavicular space; and the supraclavicular compression test which directly stresses the thoracic outlet area—are designed to reproduce the symptoms caused by TOS.