Abstract：
Background: We noted that patients with thoracic outlet syndrome (TOS) have elevation of the ipsilateral scapula and named this the scapular elevation sign (SES). The aim was to determine the prevalence of SES in a normal cohort, compare SES with other provocative tests and to determine the treatment effect on SES. Methods: First, normal asymptomatic subjects were prospectively assessed to determine the prevalence of SES in a normal cohort. Second, patients with TOS were retrospectively examined for the presence of SES and four provocative tests: supraclavicular pressure, scalene test, elevated arm stress test (EAST) and the military brace manoeuvre. All patients were initially treated non-surgically. Surgery was offered to patients with persistent symptoms at 6 months. Patients were re-examined for the presence of the SES after treatment. Results: The prevalence of SES in our normal cohort was 4% (2/53). Our study cohort included 20 patients with TOS. The SES was positive in 18 patients (90%). Supraclavicular pressure was positive in 11 (55%), scalene test in 13 (65%), EAST in 9 (45%) and military brace manoeuvre in 11 patients (55%). Following non-surgical treatment, six patients had symptom resolution, three had improvement, nine persistent symptoms and two were lost to follow-up. The SES was positive in one out of six patients with symptom resolution, two out of three patients with improvement and in all nine patients with persistent symptoms. Patients with persistent symptoms underwent surgery with symptom resolution in eight and improvement in one patient. The SES remained positive in two patients after surgical treatment. Conclusions: The SES is simple and sensitive, does not rely on variations in performance of the test and suitable for diagnosis and assessment of outcomes of TOS. Level of Evidence: Level III (Diagnostic).
摘要：
背景：我们注意到胸廓出口综合征（TOS）患者的同侧肩胛骨抬高，并将其命名为肩胛骨抬高征（SES）。目的是确定正常队列中SES的患病率，将SES与其他挑衅性测试进行比较，以确定对SES的治疗效果。方法：首先，我们对正常无症状受试者进行了前瞻性评估,以确定正常队列中SES的患病率.第二,对患有TOS的患者进行了回顾性检查，以确定是否存在SES和四项挑衅性测试：锁骨上压力，不等烯试验,手臂升高应力测试(EAST)和军事支撑动作。所有患者最初都是非手术治疗。对6个月时症状持续的患者进行手术。治疗后重新检查患者是否存在SES。结果：在我们的正常队列中，SES的患病率为4％（2/53）。我们的研究队列包括20例TOS患者。SES阳性18例(90%)。11例锁骨上压力为阳性（55%），13中的不等烯测试（65%），9例（45％）EAST和11例（55％）的军用支架动作。在非手术治疗之后,六名患者症状缓解，三人有所改善，9例持续性症状和2例失访.SES在六分之一的症状缓解患者中呈阳性，三分之二的患者有改善，所有九名患者都有持续症状。有持续症状的患者接受了手术，其中8例症状缓解，1例改善。手术治疗后，两名患者的SES保持阳性。结论：SES简单、灵敏，不依赖于测试性能的变化，适合诊断和评估TOS的结果。证据级别：III级（诊断）。
