Goodell’s sign is a medical maneuver used in the diagnosis of thoracic outlet syndrome (TOS). TOS is a condition characterized by the compression of nerves and blood vessels in the thoracic outlet, which is the space between the collarbone and the first rib. This compression can cause pain, numbness, and weakness in the arm and hand.
During the Goodell’s sign test, the physician gently palpates the area just above the collarbone, known as the supraclavicular fossa, to assess for tenderness and abnormal motion. The maneuver is named after William Goodell, an American gynecologist who first described it as a diagnostic aid for cervical cancer in 1865.
If a patient with suspected TOS experiences tenderness or pain in the supraclavicular fossa during the Goodell’s sign test, it may indicate compression of the brachial plexus or subclavian artery, two structures commonly affected in TOS. The presence of tenderness or pain in this area can help confirm the diagnosis of thoracic outlet syndrome.
What is Goodell’s sign?
Goodell’s sign is a maneuver or test used to diagnose thoracic outlet syndrome, a condition that affects the nerves and blood vessels in the upper body. It is named after William Goodell, an American physician who first described the sign in the late 1800s.
During the Goodell’s sign examination, the medical professional applies gentle pressure to the cervical region, specifically the anterior fibers of the supraspinous ligament. The patient will be in a seated or supine position, with their head and neck tilted to the opposite side being tested and the chin slightly raised. The examiner uses their fingers to palpate the area, looking for tenderness, pain, or abnormal motion.
If the patient experiences tenderness or pain upon palpation, it may indicate compression or irritation of the nerves or blood vessels in the thoracic outlet. This tenderness suggests the presence of thoracic outlet syndrome, specifically neurogenic thoracic outlet syndrome, which involves compression of the brachial plexus nerves.
How does Goodell’s sign help diagnose thoracic outlet syndrome?
Goodell’s sign is just one of several physical examinations and tests used to diagnose thoracic outlet syndrome. The presence of tenderness or pain upon palpation suggests that there is compression or irritation of the nerves or blood vessels. However, it should be noted that Goodell’s sign alone is not sufficient to make a definitive diagnosis, and further diagnostic tests, such as imaging studies or nerve conduction studies, may be necessary to confirm the condition.
Overall, Goodell’s sign is a valuable tool in the diagnostic process for thoracic outlet syndrome, as it helps healthcare professionals assess the presence of nerve and vessel compression or irritation in the cervical region. This information, combined with other clinical findings and diagnostic tests, allows for accurate diagnosis and appropriate treatment planning for the patient.
Table
| Maneuver/Test | Description |
|---|---|
| Goodell’s sign | A maneuver or test used to diagnose thoracic outlet syndrome by applying gentle pressure to the cervical region and checking for tenderness or abnormal motion. |
Definition and significance
The Goodell’s sign is a medical maneuver used to diagnose thoracic outlet syndrome. It involves the motion of the cervical spine and evaluation of the tenderness in the area. This test is commonly performed by doctors to assess the compression of the structures in the thoracic outlet, such as nerves and blood vessels.
During the Goodell’s sign test, the doctor gently palpates the supraclavicular area, which is located above the collarbone, to detect any tenderness or pain. If the patient experiences pain in this area, it may indicate the presence of thoracic outlet syndrome.
Thoracic outlet syndrome is a condition characterized by the compression or irritation of the nerves and blood vessels in the thoracic outlet, which is the space between the collarbone and the first rib. It can cause symptoms such as pain, numbness, and weakness in the shoulder, arm, and hand.
The Goodell’s sign is an important diagnostic tool as it helps doctors identify the presence of thoracic outlet syndrome and determine the appropriate treatment plan. If a patient has a positive Goodell’s sign, further tests and imaging studies may be conducted to confirm the diagnosis and determine the best course of action.
Origins and discovery
Goodell’s sign, also known as the cervical maneuver or tenderness test, is a diagnostic technique used to assess thoracic outlet syndrome (TOS). It was named after Dr. William Goodell, an American gynecologist who first described the sign in the late 19th century.
Dr. Goodell initially developed this maneuver as a means to evaluate pelvic lesions in gynecological conditions. However, it was later discovered to have diagnostic value in assessing TOS. The cervical maneuver involves palpating and applying pressure to the supraclavicular region of the affected side, specifically the subclavian artery. The presence of tenderness or pain in this area during the maneuver is considered a positive Goodell’s sign, indicative of atypical vascular compression associated with TOS.
Over the years, further research and clinical observations have refined the understanding and application of Goodell’s sign in diagnosing TOS. It has become an important tool in the assessment of thoracic outlet syndrome, helping physicians differentiate it from other similar conditions.
Application in medical diagnosis
Goodell’s sign is a medical test used in the diagnosis of thoracic outlet syndrome. It involves applying pressure to certain points in the neck and shoulder region to assess for tenderness and abnormalities in motion. By observing the patient’s response to this maneuver, doctors can gather valuable information about the potential presence of thoracic outlet syndrome.
During the Goodell’s sign test, the physician will palpate the anterior scalene muscle, located in the neck, as well as the pectoralis minor muscle, located in the chest. The patient is instructed to rotate their head and neck to the opposite side while the physician applies pressure on these muscles. If tenderness or pain is elicited, it may indicate compression or entrapment of the structures in the thoracic outlet.
In addition to tenderness, the physician also assesses the patient’s range of motion during the Goodell’s sign test. Any restriction or abnormality in motion may further support the diagnosis of thoracic outlet syndrome. This maneuver helps the physician differentiate between thoracic outlet syndrome and other conditions with similar symptoms, such as cervical radiculopathy or shoulder impingement.
Overall, Goodell’s sign is a valuable tool in the diagnosis of thoracic outlet syndrome. It allows physicians to gather important clinical information through the assessment of tenderness and motion. When used in conjunction with other diagnostic tests and medical history, Goodell’s sign can aid in accurate and timely diagnosis of thoracic outlet syndrome.
How does Goodell’s sign help diagnose thoracic outlet syndrome?
Goodell’s sign is a diagnostic test used to help identify thoracic outlet syndrome, a condition that occurs when the nerves or blood vessels in the cervical region are compressed. This sign involves assessing for tenderness and pain during cervical motion.
During the test, the healthcare provider gently palpates the supraclavicular and anterior cervical region, feeling for areas of tenderness or discomfort. Then, they ask the patient to move their head and neck in various directions, such as rotating and extending the neck.
If the patient experiences pain or tenderness during these movements, it may be indicative of thoracic outlet syndrome. This is known as a positive Goodell’s sign.
Goodell’s sign helps to pinpoint the specific location of compression, whether it is in the muscles, nerves, or blood vessels. It also aids in differentiating thoracic outlet syndrome from other conditions that may cause similar symptoms.
In addition to Goodell’s sign, healthcare providers may use other physical examination maneuvers and imaging tests to confirm the diagnosis of thoracic outlet syndrome.
In conclusion, Goodell’s sign is a valuable diagnostic tool in identifying thoracic outlet syndrome by assessing for tenderness and pain during cervical motion. It helps healthcare providers determine the location of compression and differentiate this condition from other similar ones.
Overview of thoracic outlet syndrome
Thoracic outlet syndrome is a condition characterized by compression of the nerves, blood vessels, or both, in the area between the collarbone (clavicle) and the first rib. This can result in symptoms such as pain, numbness, tingling, and weakness in the neck, shoulder, arm, and hand.
There are several causes of thoracic outlet syndrome, including anatomical variations such as a cervical rib or an extra rib. Additionally, trauma or repetitive motion can contribute to the development of the condition. The compression can occur at different points in the thoracic outlet, including the scalene muscles, the space between the first rib and clavicle, and the pectoralis minor muscle.
Diagnosis
Diagnosing thoracic outlet syndrome requires a comprehensive evaluation, which includes a thorough medical history and physical examination. During the examination, the healthcare provider will assess for signs and symptoms such as pain, tenderness, and weakness. Special maneuvers, such as the Adson’s test, Roos test, and Wright test, may be performed to provoke or reproduce the symptoms.
Goodell’s sign is one specific maneuver that can help diagnose thoracic outlet syndrome. It involves placing pressure on the supraclavicular fossa while the patient rotates their head away from the affected side. If this maneuver elicits pain, paresthesias, or reproduces other symptoms, it is considered positive and may indicate compression of the neurovascular structures in the thoracic outlet.
Imaging studies, such as X-rays, MRI scans, or ultrasound, may be ordered to further evaluate the anatomy and identify any potential causes of the compression. Electromyography (EMG) and nerve conduction studies (NCS) can be performed to assess nerve function and rule out other conditions with similar symptoms.
Treatment
The treatment for thoracic outlet syndrome depends on the underlying cause, severity of symptoms, and individual factors. Conservative treatment options include physical therapy, which focuses on improving posture, strengthening muscles, and increasing range of motion. Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain and inflammation.
In more severe cases, surgical intervention may be necessary to relieve the compression. This can involve removing an extra rib or releasing tight muscles or ligaments in the thoracic outlet. It is important to consult with a healthcare professional to determine the most appropriate treatment approach based on the individual’s specific condition and needs.
Role of Goodell’s sign in diagnosis
Goodell’s sign is a commonly used test to help diagnose thoracic outlet syndrome (TOS). It involves the assessment of the cervical spine for tenderness and motion during specific movements.
During the examination, the healthcare provider will palpate the cervical spine, specifically the area near the location of the thoracic outlet. They will look for any tenderness or discomfort during specific movements, such as flexion, extension, rotation, and lateral bending of the neck.
If the patient experiences pain or tenderness during these movements, it may suggest the presence of thoracic outlet syndrome. The Goodell’s sign is considered positive when there is reproduction of symptoms or tenderness during these cervical spine motions.
The presence of Goodell’s sign is an important aspect of the diagnosis of thoracic outlet syndrome. It helps healthcare providers differentiate TOS from other conditions that may present with similar symptoms. Additionally, it can assist in determining the specific structures or areas that are affected and contributing to the patient’s symptoms.
However, it is important to note that Goodell’s sign should not be the sole diagnostic test for thoracic outlet syndrome. It should be used in conjunction with other clinical assessments and investigations to confirm the diagnosis.
Interpretation of Goodell’s sign in thoracic outlet syndrome
In the diagnosis of thoracic outlet syndrome, one of the key tests is Goodell’s sign. This test, also known as the Goodell maneuver, is performed to assess for tenderness in the cervical region.
The Goodell’s sign is considered positive if there is tenderness or pain upon palpation of the anterior scalene muscle or the supraclavicular fossa. This sign indicates compression or irritation of the brachial plexus or subclavian artery, which are often involved in thoracic outlet syndrome.
Methodology
To perform the Goodell’s sign test, the examiner applies gentle pressure on the supraclavicular fossa or the anterior scalene muscle. The patient is asked to report any tenderness or pain experienced during the maneuver.
This test is usually conducted while the patient is sitting or lying down in a relaxed position. The examiner may repeat the maneuver on different points to assess the extent of tenderness or pain experienced by the patient.
Interpretation
If the patient experiences tenderness or pain upon palpation of the supraclavicular fossa or anterior scalene muscle, it is considered a positive Goodell’s sign. This indicates a potential compression or irritation of the brachial plexus or subclavian artery, suggesting the presence of thoracic outlet syndrome.
It is important to note that a positive Goodell’s sign alone is not sufficient to establish a diagnosis of thoracic outlet syndrome. A comprehensive evaluation by a healthcare professional, including a thorough medical history, physical examination, and additional diagnostic tests, is necessary for an accurate diagnosis.
However, the presence of a positive Goodell’s sign can provide valuable information and help guide further investigation and management of thoracic outlet syndrome.
What is cervical motion tenderness?
Cervical motion tenderness is a physical examination maneuver or sign used to assess for inflammation or infection in the reproductive organs of women. It involves applying pressure or moving the cervix during a pelvic examination to check for pain or tenderness.
This test is commonly used to diagnose conditions such as pelvic inflammatory disease (PID) or other infections in the reproductive system. It is particularly useful in detecting inflammation of the fallopian tubes (salpingitis) or the lining of the uterus (endometritis).
During the test, the healthcare provider gently moves the cervix or applies pressure to determine if there is any pain or tenderness. If the patient experiences pain during cervical motion, it may indicate an underlying infection or inflammation in the reproductive organs.
Cervical motion tenderness is considered a significant finding when evaluating patients with symptoms such as lower abdominal pain, abnormal vaginal discharge, or fever. It is an important clinical clue that can help healthcare providers determine the appropriate treatment plan.
In addition to cervical motion tenderness, other signs and symptoms may be present, such as pain during intercourse, irregular menstrual bleeding, or pain in the lower back or pelvis. It is crucial for individuals experiencing these symptoms to seek medical attention for proper diagnosis and treatment.
Definition and symptoms
In the context of thoracic outlet syndrome (TOS), Goodell’s sign is a diagnostic technique used to evaluate cervical spine motion. Specifically, it is a maneuver that helps determine whether a patient has restricted range of motion in the cervical spine, which can be a symptom of TOS.
Goodell’s test involves placing pressure on specific points in the cervical spine while asking the patient to perform various movements with their head and neck. The physician or healthcare provider will assess the patient’s range of motion during these movements, looking for any limitations or discomfort.
Individuals with thoracic outlet syndrome may experience symptoms such as pain, numbness, or tingling in the neck, shoulder, arm, or hand. Other symptoms can include weakness or fatigue in the affected area. These symptoms may be aggravated by certain activities or positions, such as lifting heavy objects or holding the arms in an elevated position for an extended period.
Causes and risk factors
Thoracic outlet syndrome (TOS) is a condition that affects the nerves and blood vessels that pass through the thoracic outlet in the upper chest and shoulder area. There are several factors that can contribute to the development of TOS.
Causes:
TOS can be caused by a variety of factors, including:
- Abnormalities in the muscles, bones, or other tissues in the thoracic outlet area
- Compression or pressure on the nerves or blood vessels from nearby structures
- Repetitive activities or overhead movements that put strain on the thoracic outlet area
- Trauma or injury to the head, neck, or shoulder
- Certain anatomical variations, such as having a cervical rib
Risk factors:
While anyone can develop TOS, there are certain factors that may increase the likelihood of developing the condition. These include:
- Participating in activities or occupations that require repetitive arm or shoulder movements
- Having poor posture
- Having a history of neck or shoulder injuries
- Having certain anatomical variations, such as a cervical rib or an extra rib
- Being female
Diagnosing TOS involves a thorough medical history, physical examination, and various tests. One of the tests commonly used is Goodell’s maneuver, also known as Goodell’s sign. This test involves palpating the supraclavicular fossa, just above the collarbone, to identify any tenderness or abnormal sensations. Goodell’s sign can help healthcare professionals evaluate for the presence of thoracic outlet syndrome.
Treatment and prevention
Treatment for thoracic outlet syndrome (TOS) depends on the underlying cause and severity of the condition. In many cases, conservative approaches are sufficient to relieve symptoms and improve function.
Some common treatments and preventive measures for TOS include:
| Physical therapy | Exercises to improve posture, strengthen muscles, and increase range of motion can help alleviate symptoms of TOS. |
| Medications | Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide pain relief, while muscle relaxants may help reduce muscle spasms in the affected area. |
| Splinting or bracing | Wearing a splint or brace that supports the affected area can help reduce strain on the muscles and nerves. |
| Lifestyle modifications | Avoiding activities that worsen symptoms and practicing good ergonomics can help prevent TOS or reduce the risk of recurrence. |
| Surgical intervention | In severe cases of TOS that do not improve with conservative treatment, surgery may be necessary to relieve pressure on the affected nerves or blood vessels. |
If you suspect you may have TOS, a medical professional can perform various tests to confirm the diagnosis, such as the Goodell’s sign, which involves tenderness and reproduction of symptoms with motion of the cervical spine.
Early diagnosis and appropriate treatment are essential for managing symptoms and preventing further complications associated with thoracic outlet syndrome.
Goodell’s test
Goodell’s test is a physical examination maneuver used to diagnose thoracic outlet syndrome, a condition that occurs when the nerves and blood vessels in the thoracic outlet (the space between the neck and shoulder) become compressed. This compression can cause pain, numbness, and tingling sensations in the arm, shoulder, and neck.
During the test, the patient is seated while the examiner palpates the cervical spine and shoulder area for tenderness and muscle tightness. The examiner then applies pressure to the anterior scalene muscle, which is located in the front of the neck, while the patient rotates their head to the opposite side. The test is positive if the patient experiences reproduction of their symptoms, such as pain or tingling, during this maneuver.
Goodell’s test helps to assess the presence of cervical spine and muscle motion restrictions and the potential compression of nerves and blood vessels in the thoracic outlet. A positive Goodell’s sign indicates the likelihood of thoracic outlet syndrome and may prompt further diagnostic tests and treatment options.
| Indications for Goodell’s test: | Procedure: | Interpretation: |
|---|---|---|
| Tenderness in the cervical spine and shoulder area | Examiner applies pressure to the anterior scalene muscle while patient rotates their head to the opposite side | Positive test if patient experiences reproduction of symptoms |
Procedure and purpose
The Goodell’s sign is a maneuver used to diagnose thoracic outlet syndrome. During the test, the examiner palpates the cervical muscles for tenderness or discomfort.
To perform the Goodell’s sign, the patient is seated and asked to flex their neck forward, rotating it to the opposite side. The examiner then applies pressure with their fingers to the supraclavicular fossa, just above the clavicle, and along the anterior scalene muscle. The patient is instructed to take a deep breath and hold it while the pressure is applied.
If the patient experiences pain, numbness, tingling, or a reduction in hand strength during this maneuver, it may be indicative of thoracic outlet syndrome. This sign suggests compression or irritation of the nerves or blood vessels in the thoracic outlet.
The purpose of the Goodell’s sign is to help identify thoracic outlet syndrome by testing for nerve or vascular compression in the cervical region. It is a simple and non-invasive test that can be performed during a physical examination to assist in the diagnosis of this condition.
Interpretation of Goodell’s test results
The Goodell’s test is a diagnostic maneuver used to assess for thoracic outlet syndrome (TOS). It involves palpating the cervical scalene muscles and assessing for tenderness or reproduction of symptoms. Here is how to interpret the results of the Goodell’s test:
Positive Goodell’s sign
If the patient experiences tenderness or reproduces their typical symptoms during the Goodell’s test, it is considered a positive sign. This suggests the presence of thoracic outlet syndrome, indicating compression or irritation of the nerves or blood vessels in the thoracic outlet.
Negative Goodell’s sign
If the patient does not experience any tenderness or reproduce their symptoms during the Goodell’s test, it is considered a negative sign. This does not definitively rule out thoracic outlet syndrome, as false negatives can occur. However, it may indicate that TOS is less likely to be the cause of the patient’s symptoms.
It is important to note that the Goodell’s test is just one component of the diagnostic evaluation for thoracic outlet syndrome. It should be used in conjunction with other clinical assessments, imaging studies, and patient history to make an accurate diagnosis and develop an appropriate treatment plan.
Goodell’s maneuver
Goodell’s maneuver, also known as the Goodell’s sign or Goodell’s test, is a diagnostic motion test used to evaluate individuals suspected of having thoracic outlet syndrome. It is named after William Goodell, an American gynecologist, who first described the maneuver in 1863.
During the Goodell’s maneuver, the examiner applies gentle pressure to the anterior cervical area while guiding the patient’s head into flexion. This motion helps to stretch and compress the structures of the thoracic outlet, including the nerves, blood vessels, and muscles. The examiner observes the patient’s response and looks for any reproduction or exacerbation of symptoms.
If the patient experiences pain, tingling, numbness, or other symptoms during the Goodell’s maneuver, it may indicate compression or irritation of the brachial plexus or blood vessels in the thoracic outlet. This positive sign can aid in the diagnosis of thoracic outlet syndrome.
The Goodell’s maneuver is one of several tests used to diagnose thoracic outlet syndrome. It is often performed in conjunction with other physical exams, medical history review, and imaging studies to determine the presence and severity of the condition.
Explanation of the maneuver
Goodell’s sign is a diagnostic test used to identify thoracic outlet syndrome. It involves the motion of the cervical spine and is named after the American gynecologist William Goodell. The maneuver is performed by placing the patient in a supine position with the examiner standing at the head of the bed.
First, the examiner palpates the anterior scalene muscle, located in the neck, to assess for tenderness or tautness. This muscle is often tense in individuals with thoracic outlet syndrome. Then, the examiner applies a gentle downward pressure on the patient’s head with their hands, causing a slight flexion of the neck and elongation of the cervical spine.
During this motion, the examiner observes the patient for any signs of pain, discomfort, or reproduction of symptoms in the upper extremities. If the patient experiences pain or discomfort, it may indicate compression of the nerves or blood vessels in the thoracic outlet.
Goodell’s sign is only one of several tests used to diagnose thoracic outlet syndrome and should be interpreted in conjunction with other clinical findings and imaging studies.
Uses and applications
Goodell’s sign is a diagnostic test used to evaluate thoracic outlet syndrome. It involves performing a specific motion or maneuver of the cervical spine to assess for compression or impingement of nerves or blood vessels in the thoracic outlet.
This test is commonly used by healthcare professionals, such as doctors and physical therapists, in the evaluation of patients presenting with symptoms suggestive of thoracic outlet syndrome, including neck pain, shoulder pain, and numbness or tingling in the upper extremities.
During the Goodell’s sign test, the patient is typically positioned in a seated or standing position, with the shoulders relaxed and the head tilted to the side. The healthcare professional then applies gentle pressure to the side of the patient’s head, tilting it even further towards the same side. This maneuver helps to stretch and mobilize the cervical spine, potentially reproducing the symptoms associated with thoracic outlet syndrome.
If the patient experiences an exacerbation or aggravation of their symptoms during the Goodell’s sign test, it may indicate compression or impingement of nerves or blood vessels in the thoracic outlet. This positive finding can assist in the diagnosis of thoracic outlet syndrome and guide further management and treatment options.
Overall, Goodell’s sign is a valuable tool in assessing for thoracic outlet syndrome and can play a crucial role in the diagnostic process, allowing healthcare professionals to provide appropriate care and interventions for patients with this condition.