Morley Test / Brachial Plexus Compression Test | Thoracic Outlet Syndrome Assessment

Thoracic Outlet Syndrome is defined as a neurovascular symptom complex associated with compression of the brachial bundle, which includes the brachial plexus and/or subclavian vessels. This compression may be caused by several anatomical structures in one or more of the following three compartments: the interscalene triangle, the costoclavicular space or retropectoralis minor space.

This test compresses the neurovascular bundle in the supraclavicular fossa. No diagnostic accuracy studies have been conducted reporting sensitivity or specificity values, which is why its clinical value remains questionable.

To perform Morley’s Test have your patient sit upright with the arms at the side of his body. Then, the examiner compresses the supraclavicular fossa for 30 seconds.
This test is considered ‘‘positive’’ if there is a reproduction of an aching sensation and typical localized paresthesia and not just mere tenderness of the area.

In some cases, fullness or even a palpable hard mass may be present in the supraclavicular. This may be an indicator of a true structural lesion potentially creating either vTOS or true neurological TOS but the mass itself must also be examined to make sure it is not of a more significant nature.

Be aware that it is unlikely that this test is able to distinguish between patients with cervical radiculopathy and TOS as this test is probably positive in both conditions.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other common tests to assess for TOS are:

• Costoclavicular / Halstead Maneuver
• Eden Test
• Cyriax Release Test
• Roos Test / Elevated Arm Stress Test
• Tinel Sign 
• Adson Test
• Wright’s Test

Watson, L. A., Pizzari, T., & Balster, S. (2009). Thoracic outlet syndrome part 1: clinical manifestations, differentiation and treatment pathways. Manual therapy, 14(6), 586-595.ISO 690