The Halstead Test is used to assess whether a thoracic outlet loading position reproduces familiar upper-limb symptoms or changes vascular signs. A positive response may include familiar arm pain, paraesthesia, heaviness, colour change, temperature change or marked pulse change with symptoms. It should not be used alone to diagnose thoracic outlet syndrome because TOS assessment remains complex and requires clinical context. Recent thoracic outlet literature continues to emphasise that diagnosis is challenging because symptoms are variable and no single objective clinical test is definitive.
A client reports arm heaviness, tingling or fatigue during overhead activity, carrying a heavy bag or prolonged shoulder positioning. Symptoms may feel different from simple neck or shoulder pain and may include vascular-type features such as coldness, colour change or swelling. The Halstead Test may help assess whether a thoracic outlet loading position reproduces familiar symptoms.
The test should be used cautiously. A positive result is not enough to diagnose thoracic outlet syndrome, and a negative result does not exclude it.
Test name: Halstead Test
Also known as: Halstead manoeuvre, sometimes described similarly to costoclavicular or military brace variations
Body region: Thoracic outlet, neck, shoulder girdle and upper limb
Purpose: Assess symptom response to thoracic outlet loading
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, neurological screen, vascular screen, cervical assessment, shoulder assessment, Roos/EAST, Adson’s, Wright Test and referral when indicated
Key limitation: It does not diagnose thoracic outlet syndrome on its own
The Halstead Test is a provocative thoracic outlet test. The professional positions the client’s shoulder girdle and upper limb, often with downward traction or depression, while the client turns the head away and extends the neck. Some versions include pulse monitoring.
Because protocol descriptions vary, the exact arm position, head position and force direction should be recorded every time.
The test is used when thoracic outlet involvement is part of the clinical reasoning.
It may help document whether a specific combination of neck, shoulder and arm positioning reproduces familiar upper-limb symptoms.
The test assesses symptom response to a thoracic outlet loading position. It may stress the neurovascular bundle, brachial plexus region, scalene region, clavicle-first rib space or shoulder girdle tissues.
It does not isolate one structure and does not confirm neurogenic, venous or arterial TOS.
This test may be useful for clients with arm heaviness, tingling, numbness, hand fatigue, symptoms with carrying, overhead activity, shoulder depression or neck and shoulder positioning.
Use when thoracic outlet symptoms are being considered and the client can tolerate the position safely.
Use caution with vascular red flags, unexplained arm swelling, colour change, coldness, suspected clotting, faintness, dizziness, severe neurological symptoms, known vascular disease, acute trauma or symptoms suggesting urgent medical review.
Stop immediately if symptoms escalate or vascular signs appear.
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.
Place the tested arm in the selected Halstead position. Commonly, the arm is slightly abducted and extended while the shoulder girdle is gently depressed.
Stand beside the client.
One hand may monitor the radial pulse if pulse monitoring is used. The other may apply gentle downward traction or guide arm position.
Keep the movement controlled and avoid forcing the shoulder or neck.
Apply gentle downward traction or depression through the shoulder/arm as per the selected method. Ask the client to turn the head away from the tested side and extend the neck if tolerated.
Ask the client to report tingling, numbness, heaviness, pain, coldness, colour change, weakness, dizziness or familiar symptoms.
A positive finding is reproduction of familiar upper-limb 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 Halstead Test may increase suspicion of thoracic outlet involvement when it reproduces familiar upper-limb symptoms or vascular-type symptoms. It does not confirm TOS.
A negative test does not exclude TOS, especially when symptoms are intermittent or provoked by different positions.
Interpretation is stronger when combined with history, vascular screen, neurological screen, cervical assessment, shoulder assessment, other thoracic outlet provocation tests and referral where appropriate.
High-quality 2020+ diagnostic accuracy values for the Halstead Test alone were not identified. Current thoracic outlet evidence supports a broader diagnostic pathway rather than relying on any single provocation test.
Recent work on the elevated arm stress test showed that even standardised thoracic outlet provocation testing can have low discriminative value for neurogenic TOS, reinforcing caution with single-test interpretation.
Reliability may be affected by arm position, force direction, head position, pulse palpation, symptom criteria and test duration.
Because Halstead protocols vary, repeatability depends on recording the exact position and symptom response.
Common errors include using pulse change alone as positive, applying too much traction, ignoring vascular symptoms, not recording head position, not documenting symptom quality and diagnosing TOS from one test.
Limitations include variable protocols, false positives, non-specific symptoms, overlap with cervical radiculopathy and peripheral nerve symptoms, and limited stand-alone evidence.
Use the Halstead Test to document symptom response to a thoracic outlet loading position. It is most useful when combined with history, cervical and shoulder assessment, neurological and vascular screening and related TOS provocation tests.
Record test name, side tested, result, pain score, symptom location, symptom quality, arm position, head position, shoulder depression/traction used, pulse response if monitored, neurological symptoms, vascular symptoms, dizziness, comparison side, confidence in result, irritability and reason for stopping.
Add related findings such as cervical ROM, shoulder ROM, Adson’s, Wright Test, Roos/EAST, grip strength, neurodynamic testing and vascular screening notes.
Adson’s Test
Eden Test
Roos Stress Test
Wright Test
Upper Limb Tension Test
Cervical ROM Tests
Shoulder ROM Tests
Grip Strength Test
It assesses symptom response to a thoracic outlet loading position involving the neck, shoulder girdle and upper limb.
A positive finding is reproduction of familiar upper-limb symptoms or vascular-type symptoms. Pulse change alone should not be treated as diagnostic.
No. It may support clinical reasoning but does not diagnose TOS on its own.
Stop for dizziness, colour change, marked symptom increase, vascular symptoms, neurological worsening or feeling unwell.
Record side, symptoms, pulse response if monitored, arm position, head position, force direction and reason for stopping.
The Halstead Test is a thoracic outlet symptom provocation test.
A positive result should reproduce familiar symptoms, not just change pulse.
It does not diagnose TOS on its own.
Safety is important when vascular symptoms are present.
Measurz should capture position, symptoms, pulse response and stopping reason.
Pesser, N., de Bruijn, B. I., Goeteyn, J., Verhofstad, N., Houterman, S., van Sambeek, M. R. H. M., Thompson, R. W., van Nuenen, B. F. L., & Teijink, J. A. W. (2022). Reliability and validity of the standardized elevated arm stress test in the diagnosis of neurogenic thoracic outlet syndrome. Journal of Vascular Surgery, 76(3), 821–829.e1.
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.
