![]() ![]() However, if the client has a negative result, it is very unlikely the client has TOS. If a therapist is uncertain whether a client has TOS, and the client has a positive result, it is still uncertain whether the client has TOS. Based on the pre-test probability, a therapist can use these diagrams to estimate the likelihood of a patient having a condition.įor example, Roos test has a low specificity and high sensitivity. (2013) also suggest some pre-test probabilities should not be tested if testing will not change the way the condition is managed however, their results are geared towards doctors whose testing may be more costly or invasive than simple provocative tests. In each of the diagrams, thicker lines mean the result is more likely to change how the condition is managed. Pre-test probability is a therapist’s estimate on whether or not a patient may have a condition based on the therapist’s clinical reasoning (The NNT Group, n.d.). (2013) offer three diagrams to assist with interpreting results of a test based on their pre-test probability, specificity, and sensitivity. (2001) lists the following sensitivity and specificities for several common TOS tests: Specificity refers to a test’s ability to correctly identify someone without the disease, while sensitivity refers to a test’s ability to correctly identify someone with the disease (New York State Department of Health, 1999). When looking at special tests, it is important to consider their specificity and sensitivity. Special tests can help a therapist determine if a patient has possible thoracic outlet syndrome and can inform care. TOS can have multiple causes, including differences in anatomy, trauma, and repetitive movement (Jones et al., 2019). Symptoms of thoracic outlet vary based on the type but can include paresthesia in the upper extremity, weakness, changes in color, and pain (National Institute for Neurological Disorders and Stroke, n.d.). There are three types of TOS – neurogenic, venous, and arterial – each based on what structure is being compressed, with neurogenic TOS being by far the most common (Jones et al., 2019). Compression can occur at the interscalene triangle, the costoclavicular triangle, and the subcoracoid space (Physiopedia, n.d.). Thoracic outlet syndrome (TOS) describes the compression of nerves, arteries, and veins as they pass through the thoracic outlet. Sensitivity and Specificity in Thoracic Outlet Syndrome (TOS) Tests in Hand Therapy
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