What is the Intermittent Claudication Test?
The intermittent claudication test detects the sign of costoclavicular compression syndrome. Let’s understand what is costoclavicular compression syndrome.
What is Costoclavicular Compression Syndrome
The costoclavicular passage is one of the three passages that make up the thoracic outlet. The other two are the costoscalene hiatus and the superior thoracic outlet.
The costoclavicular passage or pathway is formed by the
The subclavian artery, subclavian vein, and brachial nerve plexus run within the costoclavicular space between the first rib and the clavicle. Now the neurovascular bundle is susceptible to compression in this space.
Let’s understand the mechanism behind the Costoclavicular Compression Syndrome
The costoclavicular syndrome was first described in soldiers who carried loaded knapsacks. They developed numbness, pain, and fatigue in their arms as they stood in an attention position for a longer period of time.
The mechanism of compression involves the downward movement of the clavicle against the first rib with the resultant tendency to shear the neurovascular bundle.
This can occur in the following ways
- The clavicle depresses against/towards the first rib. This is evident in common postural conditions like rounding or slumping shoulders. This narrows the costoclavicular passage by pushing the scapula forward.
- The first rib elevates and the clavicle depresses.
- The first rib rises towards or against the clavicle. Clients who suffer from laboured breathing often experience this. This can also be caused by tight anterior, middle scalenes, and subclavius muscles.
- Sometimes this can be caused due to tightness in the subclavius muscle. A similar mechanism is usually followed in middle-aged, obese, or older women. The tight, narrow brassiere straps that support the heavy breasts cut the soft tissues around the shoulder and exert direct downward pressure on the clavicle, usually around the mid and lateral third junction. A scissoring action of the clavicle against the first rib narrows the costoclavicular pathway, and it finally shears (cuts) the neurovascular bundle
Symptoms of the Costoclavicular Syndrome
- Paraesthesia, pain and fatiguability of the upper limbs (arms) are the main chief complaints. Therefore, sometimes along with pain the patient, also complains of stiffness in the neck and shoulder.
- Symptoms are aggravated by exercise, and work, especially carrying heavy backpacks or shopping bags.
- Rest and sleep are good for relieving symptoms. They are usually absent or minimal in the morning and become more prominent as the day goes on (progresses).
The procedure of performing the Intermittent claudication test
Position of the Patient – The patient will be in a standing position.
Role of the Examiner
- Now, the examiner will ask the patient to abduct and externally rotate both arms.

- Then after that, the patient is instructed to rapidly bend or flex and extend the fingers of each hand for one minute.
Test Results of the Intermittent Claudication Test
If any one arm of the patient starts to droop after a few cycles of finger motion and if pain, paresthesia, or ischemic skin changes, in the arm and shoulder occurs, this indicates costoclavicular compression syndrome affecting neurovascular structures.
The reason behind this is mentioned above.
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Nerve Root Disorder Test
Duchenne Sign – Used to assess a nerve root disorder.
Thomsen Sign – Indicates or signals sciatic nerve root irritation.
Tiptoe and Heel Walking Test – Identifies or pinpoints a nerve root disorder in the lumbar spine.
Sacroiliac Joint Tests
Mennell’s Sign / Mennell’s Test – Used to assess degenerative processes in the sacroiliac joint.
Springing Test – To detect functional impairment in the Thoracic & Lumbar spine & Sacroiliac Joint.
Gaenslen’s Test – To detect any pathology or dysfunction around the sacroiliac joint.
Standing Flexion Test/ Standing Forward Flexion Test – To assess sacroiliac joint dysfunction.
Thoracic Spine Test
Ott Sign – For Measuring the ROM of the Thoracic Spine
Cervical Exams
Cervical Flexion Compression Test – To identify if there is a Herniated disk in the Cervical spine.
Jackson Compression Test – To Detect Cervical Radiculopathy (Cervical Nerve Root Compression).
Spurling Test – For Diagnosing Cervical Radiculopathy.
Cervical Distraction Test – To detect the presence of cervical radiculopathy.
Soto Hall Test – For Detecting Problem in Patient’s Neck (Cervical Spine).
Some other Tests
Pelvic Ligament Tests – used for the assessment of the pelvic ligaments.
Supported Forward Bend Test (Belt Test) – helps in differentiating lumbar pain and sacroiliac pain.
Noble Compression Test/Noble Test – To assess pain coming from iliotibial band syndrome.
Neer Test – For detecting the presence of shoulder impingement syndrome.
Subscapularis Test – Indicates rupture of the subscapularis muscle
Resources
Clinical Tests for the Musculoskeletal System: Examinations-Signs-Phenomena by K. Buckup
https://www.physio-pedia.com/Costoclavicular_Syndrome

Hello Friends,
My self Ritvik Verma and I am a Physiotherapist and the founder of www.physio-study.com. I completed my bachelor’s of physiotherapy from Integral University Lucknow and an internship at KMC Hospital Meerut.
Then I worked in the Physiotherapy Department of Lovee Shubh Hospital (Lucknow) for one year. Then I joined Holistic Touch Physical Therapy & Wellness Clinic and worked there for more than six months.
I am running my clinic and writing blogs on my website, www.physio-study.com, in my hometown, Lakhimpur Kheri.