Adson’s Test is a thoracic outlet provocation test used to observe whether a specific neck, shoulder and breathing position reproduces familiar upper-limb symptoms or produces a concerning vascular response. A positive test may include reproduction of familiar arm symptoms, paraesthesia, heaviness, vascular-type symptoms or a marked pulse change, but pulse change alone should not be interpreted as diagnostic. The test may support suspicion of thoracic outlet involvement when interpreted with history, symptom behaviour, neurological screening, vascular screening and other provocation tests. It does not confirm thoracic outlet syndrome on its own.
Thoracic outlet symptoms can be difficult to assess because neck, shoulder, brachial plexus, vascular and peripheral nerve presentations can overlap. Clients may describe arm heaviness, paraesthesia, fatigue, colour change, coldness, hand symptoms or symptoms aggravated by overhead positions. Adson’s Test is one of several provocative tests used to explore whether positioning the neck, shoulder and upper limb reproduces familiar symptoms.
During the test, the client’s head and neck are positioned while the professional monitors symptom response and may palpate the radial pulse. Historically, radial pulse reduction or disappearance was treated as an important finding. Current interpretation should be more cautious because pulse changes can occur without confirming thoracic outlet syndrome, and symptoms may be reproduced for reasons other than true neurovascular compression.
Adson’s Test is best used as one part of a broader assessment. A clear result requires careful recording of the side tested, arm position, head position, breathing instruction, symptoms, pulse response and stopping reason.
Test name: Adson’s Test
Body region: Thoracic outlet, cervical spine, shoulder girdle and upper limb
Purpose: Assess symptom response to thoracic outlet positioning
Commonly associated with: Thoracic outlet syndrome assessment and upper-limb neurovascular symptom screening
Positive finding: Reproduction of familiar upper-limb symptoms, vascular-type symptoms or marked pulse change with symptoms
Negative finding: No familiar symptom reproduction and no concerning vascular response
Best used with: History, cervical assessment, shoulder assessment, neurological screen, vascular screen, Roos/EAST, Halstead, Eden and upper-limb neurodynamic tests
Key limitation: Adson’s Test does not confirm thoracic outlet syndrome on its own.
Adson’s Test is a thoracic outlet provocation test that combines cervical extension, cervical rotation, shoulder positioning and deep breathing. The professional may monitor radial pulse while also asking the client to report familiar symptoms such as tingling, numbness, heaviness, coldness, colour change, fatigue or arm pain.
The test is intended to narrow the interscalene region and alter the relationship between the cervical spine, scalene muscles, first rib, subclavian artery and brachial plexus. However, it does not isolate one structure and cannot determine the exact cause of symptoms by itself.
Adson’s Test is used when thoracic outlet involvement is being considered as part of a broader upper-limb assessment. It may be relevant when symptoms are influenced by neck position, shoulder position, overhead activity, breathing or sustained postures.
The test may help guide further assessment by showing whether a thoracic outlet loading position reproduces familiar symptoms. It can also help identify when further neurological screening, vascular screening, medical referral or broader upper-limb assessment may be appropriate.
Adson’s Test assesses:
Symptom response to thoracic outlet positioning
Possible neurovascular symptom behaviour
Upper-limb heaviness, paraesthesia or fatigue response
Radial pulse response, if monitored
Symptom change with cervical extension and rotation
Symptom change with deep inspiration or breath hold
Safety and tolerance to provocative thoracic outlet positioning
It does not directly diagnose neurogenic, venous or arterial thoracic outlet syndrome.
Adson’s Test may be useful for clients with upper-limb symptoms that appear related to neck, shoulder, breathing or overhead positions. These symptoms may include arm heaviness, paraesthesia, numbness, hand fatigue, coldness, colour change or symptoms that increase with sustained shoulder positioning.
It may also be useful in education settings where professionals are learning how to record neurovascular symptom behaviour safely. It should be used cautiously when vascular symptoms are prominent or when red flags are present.
Use Adson’s Test when:
Thoracic outlet involvement is part of the assessment reasoning
The client has upper-limb symptoms influenced by neck or shoulder position
The client can tolerate cervical extension and rotation
You can monitor symptom behaviour carefully
Vascular and neurological symptoms can be documented clearly
The result will be interpreted with other tests, not alone
Use caution or avoid the test when there is unexplained upper-limb swelling, marked colour change, suspected vascular compromise, suspected clotting, faintness, dizziness, severe neurological deficit, acute trauma, cervical instability concern, known vascular disease, severe cervical pain or symptoms requiring urgent medical review.
Stop the test immediately if dizziness, faintness, colour change, coldness, severe paraesthesia, worsening neurological symptoms, concerning pulse change with symptoms or client distress occurs.
Adson’s Test requires minimal equipment:
Chair or safe standing space
Pain and symptom rating scale
Symptom-location recording method
Optional pulse monitoring
Measurz app for structured documentation
Optional video for posture and setup review
Optional MAT notes for cervical, shoulder and neurovascular findings
Within Measurz, Adson’s Test can be recorded alongside Roos/EAST, Halstead, Eden, Wright, cervical ROM, shoulder ROM, upper-limb neurodynamic testing, grip strength and neurological screening. Measurz supports structured notes, symptom mapping, pain scores and comparison across sessions.
Explain that the test places the neck, shoulder and upper limb in a position that may reproduce symptoms. Ask the client to report symptoms immediately, including tingling, numbness, heaviness, coldness, colour change, dizziness or familiar arm symptoms.
Record baseline symptoms before testing, including pain score, symptom location, hand temperature or colour concerns, and any current neurological or vascular-type symptoms.
The client sits or stands upright. Sitting is often preferred for safety and consistency. The tested arm may rest by the side or be slightly extended and externally rotated depending on the protocol used.
Stand beside the client on the tested side. If pulse monitoring is included, locate the radial pulse before positioning begins.
One hand may monitor the radial pulse. The other hand may guide shoulder or arm position if required. Avoid excessive pressure or forcing the arm.
Keep the client upright and relaxed. Avoid excessive cervical extension or forced shoulder positioning. The test should be provocative enough to assess symptom response but not aggressive.
A common sequence is:
Locate the radial pulse if pulse monitoring is used.
Position the tested arm according to the selected protocol.
Ask the client to extend the neck.
Ask the client to rotate the head toward the tested side.
Ask the client to take a deep breath and hold briefly if tolerated.
Monitor symptoms and pulse response.
Return to neutral and compare with the other side if appropriate.
Ask:
“Tell me immediately if you feel tingling, numbness, heaviness, coldness, dizziness or familiar symptoms.”
“Tell me if your symptoms change, spread or become stronger.”
“Let me know if this feels unsafe or uncomfortable.”
A positive finding is reproduction of familiar upper-limb neurological or vascular-type symptoms during the test position. A marked radial pulse change may be recorded, but pulse change alone should not be used as the only positive finding.
A negative finding is no familiar symptom reproduction and no concerning vascular or neurological response during the test.
Stop if symptoms increase sharply, dizziness occurs, colour change appears, the hand becomes cold, paraesthesia increases significantly, neurological symptoms worsen, pulse concerns occur with symptoms, or the client feels unwell.
Do not hold the position for longer than necessary. Do not interpret pulse change alone as diagnostic. Prioritise symptom response, safety and appropriate referral when vascular signs are concerning.
A positive Adson’s Test may increase suspicion of thoracic outlet involvement when it reproduces the client’s familiar arm symptoms or vascular-type symptoms. The finding is more meaningful when the symptom response matches the client’s history and is supported by other neurovascular or thoracic outlet findings.
A positive result does not confirm thoracic outlet syndrome or identify whether the presentation is neurogenic, venous or arterial. Symptoms may also be influenced by cervical radicular symptoms, peripheral nerve sensitivity, shoulder position, anxiety, vascular sensitivity or general symptom irritability.
A negative Adson’s Test means the tested position did not reproduce familiar symptoms or a concerning vascular response. This does not exclude thoracic outlet involvement, especially when symptoms are intermittent, activity-specific or provoked by different positions such as overhead loading.
Adson’s Test has variable diagnostic accuracy across studies and should not be interpreted as a stand-alone diagnostic test.
Gillard et al. (2001) evaluated several provocative tests in people with suspected thoracic outlet syndrome. Commonly cited values for Adson’s Test from this work are approximately:
Condition/presentation: Suspected thoracic outlet syndrome
Population: People referred with clinical suspicion of TOS
Reference standard: Final diagnosis based on available clinical and investigation findings
Sensitivity: approximately 79%
Specificity: approximately 74–76%
Key limitation: The reference standard was not a single definitive gold standard, and thoracic outlet syndrome is difficult to confirm objectively.
Later systematic review evidence has emphasised that the diagnostic accuracy of clinical tests for neurogenic and vascular thoracic outlet syndrome is limited by heterogeneous methods, variable reference standards and risk of bias. This means Adson’s Test may support clinical reasoning, but it should not be used to confirm or exclude TOS on its own.
Reliability may be affected by differences in cervical rotation, cervical extension, arm position, breath-hold duration, examiner pulse palpation, client posture and symptom criteria. Pulse palpation can be especially variable between examiners and should be interpreted cautiously.
Validity is limited because the test does not isolate the brachial plexus, subclavian artery or one specific thoracic outlet space. A positive result indicates symptom reproduction during the test position, not proof of a specific compression site or pathology.
Common errors include:
Using pulse change alone as a positive result
Holding the position too long
Forcing cervical extension or shoulder position
Ignoring dizziness, colour change or vascular symptoms
Failing to ask whether symptoms are familiar
Using the test alone to diagnose TOS
Not comparing with other thoracic outlet or cervical tests
Not recording arm position, head position or breath instruction
Missing urgent vascular referral indicators
Limitations include false positives, variable protocols, difficulty confirming TOS, overlap with cervical and shoulder symptoms, and poor stand-alone diagnostic certainty.
Adson’s Test can be useful for documenting symptom response to a thoracic outlet loading position. It may help guide whether further thoracic outlet testing, vascular screening, neurological screening or referral should be considered.
For education, the test is valuable because it teaches professionals to avoid over-relying on pulse change and to prioritise symptom relevance. The most useful record includes the exact position, symptoms reproduced, pulse response if monitored, and whether the response matched the client’s familiar symptoms.
In Measurz, record:
Test name: Adson’s Test
Side tested
Client position: sitting or standing
Arm position
Head position
Breathing instruction
Result: positive, negative, unclear or unable to test
Pain or symptom score before, during and after
Symptom location
Symptom quality
Whether symptoms were familiar
Pulse response if monitored
Vascular symptoms: colour change, coldness, swelling or heaviness
Neurological symptoms: numbness, tingling, weakness or paraesthesia
Dizziness or feeling unwell
Time held
Comparison side
Reason for stopping
Confidence in result
Related cervical, shoulder, Roos/EAST, Halstead, Eden, Wright or neurological findings
Referral notes if vascular symptoms are concerning
Recording these details improves repeatability, assessment reasoning, team communication, client education and reporting quality.
Roos Stress Test
Halstead Test
Eden Test
Wright Test
Cervical Distraction Test
Spurling’s Test
Upper Limb Tension Test
Cervical ROM Assessment
Shoulder ROM Assessment
Grip Strength Test
Neurological Screen
Adson’s Test is used to assess whether a thoracic outlet loading position reproduces familiar upper-limb neurological or vascular-type symptoms.
A positive finding is reproduction of familiar symptoms such as arm heaviness, tingling, numbness, vascular-type symptoms or marked pulse change with symptoms.
No. It may support suspicion of thoracic outlet involvement, but it does not diagnose TOS on its own.
Pulse change alone should be interpreted cautiously. Symptom reproduction and clinical context are more important than pulse change by itself.
A negative result means the test did not reproduce familiar symptoms or a concerning vascular response. It does not fully exclude thoracic outlet involvement.
Stop for dizziness, colour change, coldness, worsening neurological symptoms, marked symptom escalation or feeling unwell.
Record side, arm position, head position, breathing instruction, symptoms, pulse response if used, vascular signs, neurological signs and reason for stopping.
Adson’s Test is a thoracic outlet symptom provocation test.
A positive result is most meaningful when familiar symptoms are reproduced.
Pulse change alone is not diagnostic.
The test should be interpreted with history, cervical, shoulder, neurological and vascular findings.
Measurz should capture symptoms, pulse response, position, safety response and related findings.
Dessureault-Dober, I., Bronchti, G., & Bussières, A. (2018). Diagnostic accuracy of clinical tests for neurogenic and vascular thoracic outlet syndrome: A systematic review. Journal of Manipulative and Physiological Therapeutics, 41(9), 789–799. https://doi.org/10.1016/j.jmpt.2018.02.007
Gillard, J., Pérez-Cousin, M., Hachulla, É., Remy, J., Hurtevent, J. F., Vinckier, L., Thévenon, A., & Duquesnoy, B. (2001). Diagnosing thoracic outlet syndrome: Contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine, 68(5), 416–424.
Hooper, T. L., Denton, J., McGalliard, M. K., Brismée, J. M., & Sizer, P. S. (2010). Thoracic outlet syndrome: A controversial clinical condition. Part 1: Anatomy, and clinical examination/diagnosis. Journal of Manual & Manipulative Therapy, 18(2), 74–83. https://doi.org/10.1179/106698110X12640740712734
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
