White Hand Sign
Up RSD Plethysmography White Hand Sign





Carlos A. Selmonosky, M. D

North Georgia Medical Center, Ellijay, Georgia.

The thoracic outlet syndrome is a positional compression of the subclavian artery, vein, and brachial plexus nerves in the so-called thoracic outlet area. The degree of compression and the involvement of each of the anatomical areas varies.

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The diagnosis of thoracic outlet syndrome is very simple if awareness of its existence by the examining physician is present. Its incidence in the general population varies from 8 to 15%. Objective evidence of its diagnosis is commonly obtained by vascular studies, angiograms, nerve conduction tests, F wave studies, etc. If the vascular positional compression is severe, an assumption that the nearby nerves will be compressed can be made. A simple objective tests to detect positional vascular compression is a picture of the hands elevated above the shoulder girdle toward the ceiling, with the palms facing the observer. A severe vascular positional compression will be shown by the paleness of one or both of the hands according to the degree of vascular compression.

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This picture, when compared to the neutral position, with the hands resting at the sides of the patient, will be an objective measure of the severity of the positional vascular compression. The absence of color changes in the elevated hands should not be construed that the thoracic outlet syndrome is not present. Severe neural compression can exist without vascular compression. The opposite, severe positional vascular compression associated with nerve compression, is commonly observed.

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Therefore, objective evidence of positional vascular compression at the thoracic outlet could be obtained in the physician's office with minimal expenses.