A simple objective test to assess the positional vascular obstruction at the thoracic outlet is the observation of the change of color 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, see the Selmonosky Positional Maneuver. The appearance of a severe 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 physicians who are aware of its protean symptoms. The White Hand Sign will objectively assess the postural arterial 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 noticeable vascular compression.
The use in the physical examination of the Selmonosky Diagnostic Triad (SDT), 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 SDT in the routine physical examination, it will standardize the diagnosis of Thoracic Outlet Syndrome.