In a patient with neck and arm symptoms suggestive of thoracic outlet syndrome, which test would you most likely perform?

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The key idea here is using a nerve-root–specific provocative maneuver to determine if neck and arm symptoms come from cervical radiculopathy rather than from thoracic outlet compression. The foraminal compression test works by loading the exiting cervical nerve roots through the intervertebral foramina. When the head is positioned to open the foramina (typically with slight extension and rotation toward the symptomatic side) and a downward axial load is applied, a positive reproduction of sharp or radiating pain in a familiar dermatomal/myotomal distribution indicates nerve-root irritation from foraminal encroachment or cervical nerve pathology. This helps distinguish cervical radiculopathy from thoracic outlet syndrome, since thoracic outlet tests (like Roos, Adson, and similar maneuvers) specifically stress the neurovascular structures at the thoracic inlet and are more likely to reproduce symptoms related to vascular or neural compression in that region. In a patient where neck and arm symptoms could be due to cervical nerve involvement, the foraminal compression test is particularly useful to confirm radiculopathy as the source, guiding further evaluation and management.