Intermittent Claudication Test

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

• Scapula – Posteriorly
• First rib – Medially
• Clavicle – Antero-laterally

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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Resources

Clinical Tests for the Musculoskeletal System: Examinations-Signs-Phenomena by K. Buckup

https://www.physio-pedia.com/Costoclavicular_Syndrome