The Halstead Test, sometimes referred to as the reverse Adson manoeuvre, is a thoracic outlet symptom provocation test. It usually combines downward traction or depression of the shoulder girdle with cervical positioning while monitoring upper-limb symptoms and, in some protocols, radial pulse response. A positive finding may include reproduction of familiar arm symptoms, paraesthesia, heaviness, vascular-type symptoms or a marked pulse change with symptoms. The test does not diagnose thoracic outlet syndrome on its own and should be interpreted with history, vascular screening, neurological screening and other thoracic outlet tests.
Thoracic outlet syndrome assessment is challenging because symptoms can overlap with cervical radiculopathy, peripheral nerve sensitivity, shoulder pathology, vascular conditions and postural loading responses. The Halstead Test is one of several provocative tests used to explore whether thoracic outlet positioning reproduces familiar upper-limb symptoms.
The test generally places the shoulder girdle and cervical region in a position that may tension or narrow parts of the thoracic outlet. The professional may monitor the radial pulse and ask the client to report symptoms such as arm heaviness, paraesthesia, numbness, coldness, colour change or familiar pain.
Interpretation must be careful. Pulse changes can occur in people without thoracic outlet syndrome, and symptom reproduction can occur for reasons other than true neurovascular compression. For this reason, the Halstead Test is best used as part of a broader assessment rather than as a stand-alone test.
Test name: Halstead Test
Also known as: Halstead Manoeuvre, Reverse Adson Test, Costoclavicular/traction-style TOS provocation variation
Body region: Thoracic outlet, cervical spine, shoulder girdle and upper limb
Purpose: Assess symptom response to thoracic outlet loading and shoulder girdle depression
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 or neurological response
Best used with: Adson’s Test, Eden Test, Roos Stress Test, Wright Test, cervical assessment, shoulder assessment, neurological screen and vascular screen
Key limitation: The Halstead Test does not confirm thoracic outlet syndrome on its own.
The Halstead Test is a thoracic outlet provocation test used to assess whether a combination of shoulder girdle depression, arm traction and cervical positioning reproduces symptoms. In many descriptions, the client’s head is rotated away from the tested side while the shoulder or arm is gently depressed or tractioned.
The test may narrow or tension parts of the thoracic outlet region, but it does not isolate one structure. Symptoms may arise from brachial plexus sensitivity, vascular sensitivity, cervical contributions, shoulder girdle loading, scalene sensitivity or peripheral nerve involvement.
The Halstead Test is used when thoracic outlet involvement is being considered. It may be relevant when a client reports upper-limb heaviness, paraesthesia, numbness, coldness, fatigue, colour change, symptoms with overhead activity, or symptoms influenced by neck and shoulder position.
The test may help determine whether further thoracic outlet assessment, neurological screening, vascular screening or referral discussion is appropriate. It should always be interpreted with the client’s history and related findings.
The Halstead Test assesses:
Symptom response to thoracic outlet positioning
Upper-limb paraesthesia, heaviness or fatigue response
Vascular-type symptom behaviour
Radial pulse response, if monitored
Symptom change with shoulder girdle depression or traction
Symptom change with cervical rotation
Safety and tolerance to provocative positioning
It does not directly diagnose neurogenic, venous or arterial thoracic outlet syndrome.
The test may be useful for clients with upper-limb symptoms that appear influenced by shoulder girdle position, neck posture, load carriage, overhead activity or sustained arm positions.
It may also be useful in education settings where professionals are learning thoracic outlet assessment and neurovascular symptom documentation. It should be used cautiously when vascular symptoms are prominent or when safety red flags are present.
Use the Halstead 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 gentle shoulder depression or traction
You can monitor symptom behaviour carefully
You can screen for concerning vascular or neurological signs
The result will be interpreted with other tests, not alone
Use caution or avoid the test when there is unexplained arm swelling, colour change, marked temperature 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 immediately if dizziness, faintness, colour change, coldness, severe paraesthesia, worsening neurological symptoms, concerning pulse change with symptoms or client distress occurs.
The Halstead 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, the Halstead Test can be recorded alongside Adson’s Test, Eden Test, Wright Test, Roos Stress Test, cervical ROM, shoulder ROM, upper-limb neurodynamic testing, neurological screening and grip strength. Measurz helps capture position, symptom response, pulse change, safety findings and related test results.
Explain that the test places the neck, shoulder and arm 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.
Stand beside or behind 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 at the wrist. The other hand may gently depress the tested shoulder girdle or guide the arm depending on the protocol used.
The client should remain upright and relaxed. Avoid excessive cervical movement or aggressive traction.
A common sequence is:
Locate the radial pulse if pulse monitoring is used.
Gently depress or traction the tested shoulder girdle or arm.
Ask the client to rotate the head away from the tested side.
Some protocols add cervical extension or deep inspiration, depending on the variation.
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 the hand feels cold, heavy or different.”
“Tell me 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 criterion.
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 use aggressive shoulder depression or traction. Do not hold the test position longer than necessary. Prioritise symptom response and client safety over pulse findings alone.
A positive Halstead Test may increase suspicion that thoracic outlet loading is relevant when it reproduces familiar upper-limb neurological or vascular-type symptoms. It is more meaningful when the symptom response matches the client’s history and is supported by other thoracic outlet, neurological or vascular findings.
A positive result does not confirm thoracic outlet syndrome or identify whether symptoms are neurogenic, venous or arterial. Symptoms may also be influenced by cervical radicular symptoms, shoulder girdle loading, peripheral nerve sensitivity, scalene sensitivity, anxiety, vascular sensitivity or general irritability.
A negative Halstead Test means the tested position did not reproduce familiar symptoms or a concerning vascular response. This does not exclude thoracic outlet involvement, especially if symptoms occur only during overhead tasks, exercise, load carriage or prolonged postures.
Diagnostic accuracy for thoracic outlet provocative tests is variable and should be interpreted cautiously. Halstead-specific diagnostic accuracy evidence is limited compared with more commonly studied TOS tests.
Gillard et al. (2001) evaluated provocative testing as part of a broader thoracic outlet assessment. Their work supports the general principle that combinations of TOS tests may provide more useful information than isolated manoeuvres, but no single provocative test should be considered confirmatory.
A later study examining clinical diagnostic tests for TOS reported Halstead manoeuvre sensitivity values in the mid-70% range across examiners, but sensitivity alone does not confirm diagnostic usefulness because specificity, reference standard quality and false positive rates matter. Systematic review evidence has emphasised that diagnostic accuracy studies for neurogenic and vascular TOS are heterogeneous and limited by variable criteria.
Overall, the Halstead Test should be interpreted as a symptom provocation and screening tool rather than as a stand-alone diagnostic accuracy test.
Reliability may be affected by differences in shoulder depression force, arm traction, cervical rotation, breath instruction, pulse palpation, client posture and symptom criteria. Pulse monitoring is especially examiner-dependent and should be interpreted cautiously.
Validity is limited because the test does not isolate one thoracic outlet space or structure. A positive result indicates symptom reproduction during a provocative position, not proof of neurovascular compression.
Validity improves when the finding is interpreted with a careful history, symptom behaviour, neurological examination, vascular screening, cervical assessment, shoulder assessment and other TOS provocation tests.
Common errors include:
Using pulse change alone as a positive result
Applying excessive shoulder depression or traction
Holding the test too long
Ignoring dizziness, colour change or coldness
Failing to ask whether symptoms are familiar
Using the test alone to diagnose TOS
Not recording head position, arm position or force direction
Ignoring cervical radiculopathy or peripheral nerve contributors
Missing urgent vascular referral indicators
Limitations include false positives, variable protocols, uncertain reference standards for TOS, overlap with cervical and shoulder symptoms, and limited stand-alone diagnostic certainty.
The Halstead Test can be useful when documenting whether shoulder girdle depression and cervical positioning reproduce upper-limb symptoms. It may guide whether further thoracic outlet testing, vascular screening, neurological screening or referral is needed.
For education, the test reinforces the importance of symptom relevance. A pulse change without familiar symptoms should be interpreted carefully, while familiar symptom reproduction with vascular-type changes should be documented clearly and managed within professional scope.
In Measurz, record:
Test name: Halstead Test
Side tested
Client position: sitting or standing
Arm position
Shoulder depression or traction used
Head position
Breathing instruction if used
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 Adson’s, Eden, Roos, Wright, cervical, shoulder, neurological and vascular findings
Referral notes if vascular symptoms are concerning
Recording these details improves repeatability, assessment reasoning, team communication, client education and reporting quality.
Adson’s Test
Eden Test
Roos Stress Test
Wright Test
Cervical Rotation Lateral Flexion Test
Cervical Distraction Test
Spurling’s Test
Upper Limb Tension Test
Cervical ROM Assessment
Shoulder ROM Assessment
Grip Strength Test
Neurological Screen
The Halstead 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, coldness, colour change or vascular-type symptoms during the test position.
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 meaningful 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, pulse concern with symptoms or feeling unwell.
Record side, arm position, head position, shoulder depression or traction, symptoms, pulse response if used, vascular signs, neurological signs and reason for stopping.
The Halstead 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
Yildizgoren, M. T., & Ekiz, T. (2022). Diagnostic values of clinical diagnostic tests in thoracic outlet syndrome. Turkish Journal of Physical Medicine and Rehabilitation, 68(1), 54–60.
