Adson’s Test is a thoracic outlet provocation test that combines neck movement, shoulder position and breathing while monitoring symptoms and sometimes radial pulse change. A positive finding may include reproduction of familiar arm symptoms, vascular symptoms or marked pulse change, but pulse change alone is not enough to diagnose thoracic outlet syndrome. Recent reviews emphasise that thoracic outlet syndrome remains challenging to diagnose because symptoms are non-specific and objective diagnostic consensus is limited.
A client reports arm heaviness, tingling, colour change or symptoms that worsen with overhead positions. Cervical and shoulder assessment provide some information, but symptoms appear related to positions that load the thoracic outlet region. Adson’s Test may help assess whether a specific head, neck, breathing and shoulder position reproduces familiar symptoms.
The test must be interpreted cautiously. Many provocative thoracic outlet tests can reproduce symptoms in people without true thoracic outlet syndrome, and pulse changes can occur without confirming pathology.
Test name: Adson’s Test
Body region: Thoracic outlet, neck, shoulder, upper limb and neurovascular bundle
Purpose: Assess symptom response to thoracic outlet positioning
Commonly associated with: Thoracic outlet syndrome assessment
Positive finding: Reproduction of familiar neurological or vascular symptoms, with or without marked pulse change
Negative finding: No familiar symptom reproduction and no concerning vascular response
Best used with: History, neurological screen, vascular screen, cervical assessment, shoulder assessment, Roos/EAST, ULTT and referral when indicated
Key limitation: Adson’s Test does not diagnose thoracic outlet syndrome on its own
Adson’s Test is a provocative test for thoracic outlet symptom response. The client’s arm and shoulder are positioned while the head is turned and extended. The client may be asked to inhale deeply and hold the breath while the professional monitors symptoms and radial pulse.
The test aims to assess whether the position reproduces familiar neurovascular symptoms.
Adson’s Test is used when thoracic outlet involvement is being considered.
It may be relevant when a client reports:
Arm heaviness
Tingling or numbness
Symptoms with overhead activity
Colour or temperature changes
Hand fatigue
Symptoms related to neck, shoulder or first rib position
Vascular-type symptoms requiring caution
The test assesses symptom response to a thoracic outlet loading position. It may involve brachial plexus, subclavian artery or surrounding structures, but it does not isolate one structure.
It does not confirm neurogenic, venous or arterial thoracic outlet syndrome.
This test may be useful for clients with upper-limb symptoms related to overhead positions, neck/shoulder posture, arm heaviness, neurovascular symptoms or suspected thoracic outlet involvement.
Use when thoracic outlet symptoms are part of the clinical reasoning and the client can tolerate the position safely.
Use caution with severe vascular symptoms, known vascular disease, unexplained swelling, colour change, suspected clotting, faintness, dizziness, significant neurological deficit, acute trauma or symptoms suggesting urgent medical review.
Stop immediately if vascular or neurological symptoms escalate.
Chair or standing space
Pain and symptom scale
Pulse monitoring if used
Measurz recording workflow
Optional vascular and neurological screen notes
Position the client sitting or standing upright.
The tested arm rests at the side or is slightly extended and externally rotated depending on the selected protocol.
Stand beside the client and locate the radial pulse if pulse monitoring is included.
One hand may monitor the radial pulse. The other hand may guide arm or shoulder position if required.
Keep the movement controlled and avoid forcing cervical extension or shoulder position.
Ask the client to extend and rotate the head toward the tested side. The client may be asked to take a deep breath and hold briefly.
Ask the client to report tingling, numbness, heaviness, pain, colour change, coldness, dizziness or familiar symptoms.
A positive finding is reproduction of familiar arm symptoms, vascular-type symptoms or a marked pulse change with symptoms.
A negative finding is no familiar symptom reproduction and no concerning vascular response.
Stop if symptoms increase sharply, dizziness occurs, colour change appears, neurological symptoms worsen, pulse concerns are noted or the client feels unwell.
Do not interpret pulse change alone as diagnostic. Prioritise symptom reproduction and safety.
A positive Adson’s Test may increase suspicion of thoracic outlet involvement when it reproduces familiar arm symptoms or vascular-type symptoms. Pulse reduction or disappearance should be interpreted cautiously and should not be used alone to diagnose TOS.
A negative test does not exclude TOS, especially when symptoms are intermittent, activity-specific or provoked by different overhead positions.
Interpretation is stronger when combined with history, symptom distribution, vascular screen, neurological screen, cervical assessment, shoulder assessment, other thoracic outlet provocation tests and referral where appropriate.
Recent thoracic outlet literature emphasises that diagnosis remains difficult because symptoms are non-specific, objective diagnostic consensus is limited and presentations vary between neurogenic, venous and arterial TOS.
High-quality 2020+ diagnostic accuracy values for Adson’s Test alone were not identified. Therefore, no sensitivity, specificity or likelihood ratio values are included.
Reliability may be affected by head position, shoulder position, breath-hold duration, examiner pulse palpation, client posture and symptom criteria.
Recent consensus and review literature supports a multi-factor diagnostic approach to TOS rather than relying on any single provocative test.
Common errors include using pulse change alone as positive, ignoring symptoms, holding the position too long, forcing neck extension, failing to screen vascular red flags and diagnosing TOS from one test.
Limitations include false positives, variable protocols, non-specific symptoms, pulse interpretation difficulty and poor stand-alone diagnostic certainty.
Use Adson’s Test to document symptom response to a thoracic outlet loading position. It is most useful when combined with a full history, cervical and shoulder assessment, neurological and vascular screen, and other symptom provocation findings.
Record test name, side tested, result, pain score, symptom location, symptom quality, arm position, head position, breathing instruction, pulse response if monitored, neurological symptoms, vascular symptoms, dizziness, comparison side, confidence in result, irritability and reason for stopping.
Add related cervical ROM, shoulder ROM, upper-limb neurodynamic findings, grip or strength findings, vascular screen notes and referral considerations where relevant.
Upper Limb Tension Test
Shoulder ROM Tests
Neck Rotation Test
Neck Extension Test
Grip Strength Test
Roos/EAST Test
Posture Assessment
Neurological Screen
It assesses symptom response to a thoracic outlet loading position involving the neck, shoulder and upper limb.
A positive result is reproduction of familiar arm symptoms or vascular-type symptoms. Pulse change alone is not enough.
No. It may support suspicion but does not diagnose TOS on its own.
Stop for dizziness, marked symptom increase, colour change, coldness, neurological worsening or feeling unwell.
Record side, symptoms, pulse response if monitored, arm position, head position, breathing instruction and reason for stopping.
Adson’s Test is a thoracic outlet symptom provocation test.
Pulse change alone is not diagnostic.
TOS assessment requires history, screening and clinical context.
Safety is important when vascular symptoms are present.
Measurz should capture symptoms, pulse response, position and stopping reason.
Masocatto, N. O., Da-Matta, T., Prozzo, T. G., Couto, W. J., & Porfirio, G. (2022). Thoracic outlet syndrome: A narrative review. Frontiers in Cardiovascular Medicine, 9, 802183. https://doi.org/10.3389/fcvm.2022.802183
