THE WHITE HAND SIGN, A NEW SIMPLE MANEUVER USEFUL IN THE DIAGNOSIS OF
THORACIC OUTLET SYNDROME

Southern Medical Association. 96th Annual Scientific Assembly - Washington,
November 13-16, 2002

A simple objective test to assess the positional vascular obstruction at the thoracic outlet is the observation of the change of colors of the hands when the patient elevates the hands above the shoulder girdle, with the fingers pointed to the ceiling and the palms facing the observer. The appearance of the paleness, sometimes cadaveric, in one or both hands is called the White Hand Sign.

Thoracic Outlet Syndrome is a group of symptoms arising not only from the upper extremity, but also from the chest, neck, shoulders and head. The symptoms are produced by a positional intermittent compression of the brachial plexus and/or subclavian artery, vein and the vertebral artery; the diagnosis is readily suspected by the physician who is aware of the symptoms. The White Hand Sign will objectively assess the postural vascular compression at the thoracic outlet. The absence of the color changes on the elevation of the hands should not be construed that Thoracic Outlet Syndrome is not present, severe nerve compression can exist without vascular compression.

The use in the physical examination of a triad consisting of tenderness of the supraclavicular area, paleness and/or paresthesias on elevation of the hands, and weakness of the abductors and adductors of the 5th finger, will make the diagnosis of Thoracic Outlet Syndrome consistent and reproducible.

A new physical sign called the White Hand Sign is described. When used with the diagnostic triad in the routine physical examination, it will standardize the diagnosis of Thoracic Outlet Syndrome.