As the patient's symptoms were reproduced both on digital pressure of the pectoralis minor muscle and when performing Wright's test it was not considered necessary to initially perform any imaging, electrodiagnostic studies or further vascular examinations.
Following this, Wright's test was found to be negative and digital pressure over the pectoralis minor muscle no longer reproduced the patient's symptoms.
He was again treated in the same manner and was also given a home stretch to release his pectoralis minor muscle, with specific instructions on the manner in which to stretch so as to not hyperabduct and trigger his symptoms.
From the examination that was carried out by the author the two most important indications for a diagnosis of thoracic outlet syndrome were the reproduction of the patient's symptoms on sustained digital pressure on both the muscle belly of the pectoralis minor muscle and at its tendinous attachment at the coracoid process, and the positive Wright's test.
These muscles did not display a weakness when examined in a normal position and this further indicates that a change in the position and length of the pectoralis minor muscle was causing pressure and/or irritation to the neurovascular bundle that lead to the ulnar nerve, which in turn supplies both of these muscles of the hand.
The course of the axillary artery is divided into three parts by the pectoralis minor muscle (Williams et al.
It then traversed behind the pectoralis minor muscle and 1.
Yotova & Novakov (2004) observed division of the axillary artery into regular and variant branches at the upper border of pectoralis minor muscle.
1980) reported the origin of the profunda brachial artery from deep brachiothoracic artery at the level of inferior border of pectoralis minor muscle.