DR. W.N. DUDLEY, D. C. Howell, Michigan
The Adson's sign is usually described as examination of the patient while the patient is seated; the radial pulse is held, the patient is instructed to take I a deep breath and turn the head to the side opposite of the hand held. If the pulse is shut off the sign is positive.1 The sign can occur on either radial pulse and is generally considered in a cervical rib only. However, if the Adson's sign is done to the population at random, it will be found positive on the one side as high as 90% of the time. There is a modification to be considered that is the pulse will alter or slow down and this is considered a modified positive.
It is noteworthy that there are several cases in which the sign will be altered. One is that if the individual patient has fasted, the sign tends to be the "true" sign. The sign may switch if the patient is then given sucrose on the tongue, Therefore, a fasting sign must be noted to delineate the actual side of the sign. The sign may be noted in a sitting, standing, or reclining position. Therefore, ruling out the necessity for seated posture as the sign is actually an indicator for uneven contraction of the scalenus anticus bilaterally.
X-ray findings correlate the side of the curvature to the spine as being the same sign as the Adson's sign. For example a right Adson's sign would show a right cervical curve. When the side is opposite to the curve of the spine, it is found that the patient has an extreme degree of nerve pressure. This is seen in acute conditions only.
Muscle testing would obviously determine the side of the Adson's sign. This is not without its validity. The weak scalenus anticus cannot pull as firmly as the strong side and therefore the right Adson's sign will always show a weak left scalenus anticus.
An interesting correlation here is found in a fasting individual, if the muscle testing has been done and recorded. The patient is dosed with a small amount of sucrose on the tongue and the muscle tests then change. It has been Dr. Goodheart's 2 contention that he has never seen a diabetic that did not have a weak latissimus dorsi muscle. It is my experience that this is true and that the scalenus will also be weak along with the latissimus dorsi--and usually on the same side. This has importance because when the fasting patient is given sucrose on the tongue the scalenus and the latissimus weaken immediately. Therefore, the muscle testing of an individual should be done in a fasting condition.
The adjustment that I have done has been in a cervical chair for the correction of the lower cervical spine. The adjustment is always from the same side as the Adson's sign. However, this is often done guardedly. Especially when the cervical x-ray may show a curve opposite to the Adson's sign. If that patient is adjusted in that manner I it is my experience that the body then is dictating its needs, because often after the initial adjustments the Adson's sign will alter to the opposite side. The adjustment is then altered to conform to the Adson's sign. Responses of the nervous system have validated this approach. It goes even further, and that is, that most commonly the Atlas is adjusted from the opposite side of the Adson's sign. Again the side of correction may shift rapidly. It is not without some hesitation that this conclusion has been reached. It is the rare patient that needs correction other than as defined above. One exception is: A right Adson's sign is noted; muscle tests define for example, a weak gluteus minimus on the right. The patient is adjusted to correct the weakness. The Adson's sign then becomes opposite; cervical correction is made and the adjustment has a durability that is unique.
Examinations of the cranial nerves to determine impairment have shown that these nerves regain function more rapidly when this procedure is followed. Cases such as trigeminal and tragus nerve impairment, etc., have all shown remarkable and rapid response. Even in instances where the cervical spine is deformed and/or arthritic, following the Adson's sign has more validity than the x-ray listing.
It is amazing and frustrating to adjust a patient with some degree of regularity and see the shift in the Adson's sign. But whether it is through muscle testing, cranial nerve examination, or any other device used--the Adson's sign has remained a more reliable indicator of the patient's need than any other indicator the author has used to date.
References
1. Chusid, J. G.: Correlative Neuromatomy and Functional Neurology, 14th edition 1970,
2. Goodheart, G.: Personal communications.
THE ACA JOURNAL OF CHIROPRACTIC, DECEMBER 1972