Cervical and TOS Clinical Reasoning Guide

Cervical Pain + Thoracic Outlet Syndrome Clinical Reasoning Guide

Take the guesswork out of complex cervical and upper-quarter presentations.

This Clinician Compass guide is designed to help physical therapists move beyond isolated special tests and build a clearer clinical reasoning process for patients with acute cervical pain, radiating symptoms, suspected disc involvement, thoracic outlet syndrome, and T4 syndrome.

Inside, you’ll find practical guidance for differentiating common cervical disc presentations, recognizing patterns that may suggest TOS or T4 syndrome, interpreting neurological and vascular symptoms, selecting appropriate provocation tests, and connecting examination findings to treatment.

The guide also includes clinical considerations for axial separation, first-rib and thoracic dysfunction, manual therapy, neural mobility, patient education, and home-management strategies.

Designed for clinicians who want to:

• Improve cervical and upper-quarter differential diagnosis
• Differentiate cervical pathology from neurogenic TOS and T4 syndrome
• Recognize important symptom and referral patterns
• Better interpret tests such as Roos/EAST, Cyriax Release, Adson, Eden, and Wright
• Connect examination findings to a targeted treatment plan
• Build a more confident, repeatable clinical reasoning process

A practical reference you can use in the clinic, during mentorship, or while studying complex cervical and upper-quarter cases.

For educational purposes only. Intended for licensed healthcare professionals and healthcare students.