White Hand sign
The white hand sign is a medical sign observed as a visible whitening of skin on the hand when the subject elevates the hands above the shoulder girdle with fingers pointing to the ceiling and palms facing forward. The appearance of the paleness, sometimes cadaveric, in one or both hands is called the White Hand Sign. It results from this change in position causing a compression of the subclavian artery and temporary loss of circulation, as often occurs in patients with thoracic outlet syndrome, a complex syndrome involving the compression of various nerves and blood vessels between the axilla (armpit) and the base of the neck.
The White Hand Sign will objectively assess the postural vascular compression at the thoracic outlet. The absence of the color changes on the elevation of the hands should not be construed that Thoracic Outlet Syndrome is not present, severe nerve compression can exist without vascular compression.
The use in the physical examination of a triad consisting of tenderness of the supraclavicular area, paleness and/or paresthesias on elevation of the hands, and weakness of the abductors and adductors of the 5th finger, will make the diagnosis of Thoracic Outlet Syndrome consistent and reproducible.
A new physical sign called the White Hand Sign is described. When used with the diagnostic triad in the routine physical examination, it will standardize the diagnosis of Thoracic Outlet Syndrome.
