The Eden Test, also known as the Costoclavicular or Military Brace Test, assesses whether a shoulder girdle posture reproduces familiar thoracic outlet symptoms. A positive finding may include familiar arm heaviness, paraesthesia, pain, colour change, temperature change or marked pulse change with symptoms. It should be interpreted as one finding within a broader thoracic outlet assessment, not as a diagnosis. Current TOS literature continues to highlight diagnostic uncertainty and the need for clinical context.
A client notices arm symptoms when wearing a heavy backpack, carrying load, pulling the shoulders back or standing in a military-style posture. The symptoms may include heaviness, tingling, numbness or fatigue in the arm. The Eden Test may help assess whether narrowing the costoclavicular space reproduces familiar symptoms.
Because many positions can provoke non-specific upper-limb symptoms, the result should be recorded carefully and interpreted alongside history, neurological and vascular screening, cervical assessment and shoulder assessment.
Test name: Eden Test
Also known as: Costoclavicular Test, Military Brace Test
Body region: Thoracic outlet, costoclavicular space, shoulder girdle and upper limb
Purpose: Assess symptom response to costoclavicular loading
Positive finding: Familiar upper-limb symptoms or vascular-type symptoms during the test position
Negative finding: No familiar symptom reproduction and no concerning vascular response
Best used with: History, vascular screen, neurological screen, cervical ROM, shoulder assessment, Adson’s, Halstead, Wright and Roos/EAST
Key limitation: It does not diagnose thoracic outlet syndrome on its own
The Eden Test is a thoracic outlet provocation test that places the shoulder girdle in a posture thought to reduce the costoclavicular space. The client usually draws the shoulders down and back while the professional monitors symptoms and, in some versions, radial pulse.
The test is also called the Military Brace Test because the posture resembles a braced upright position.
The test is used when symptoms may be provoked by load or posture around the clavicle, first rib and shoulder girdle.
It may be relevant when symptoms occur with carrying bags, backpack use, shoulder bracing, military posture, prolonged standing or loaded shoulder depression.
The test assesses symptom response to costoclavicular loading. It does not isolate the subclavian vessels, brachial plexus, first rib or clavicle.
It does not confirm neurogenic, venous or arterial TOS.
This test may be useful for clients with arm heaviness, fatigue, tingling, numbness, hand symptoms or vascular-type symptoms that appear linked to shoulder girdle position or carrying load.
Use when costoclavicular or thoracic outlet involvement is being considered and the client can tolerate the position safely.
Use caution with unexplained swelling, colour change, coldness, suspected clotting, known vascular disease, faintness, dizziness, progressive neurological symptoms, acute trauma or symptoms suggesting urgent medical review.
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.
Ask the client to draw the shoulders down and back, or assume the selected costoclavicular posture.
Stand beside or in front of the client.
One hand may monitor the radial pulse if included. Observation of colour, posture and symptom behaviour is essential.
Avoid forcing shoulder retraction or depression.
Maintain the braced posture briefly while symptoms are monitored. Some versions include resisted or maintained shoulder depression.
Ask the client to report tingling, numbness, heaviness, pain, fatigue, coldness, colour change, swelling sensation 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, vascular signs appear, dizziness occurs, neurological symptoms worsen or the client feels unwell.
Do not rely on pulse change alone. Record symptom behaviour and whether symptoms are familiar.
A positive Eden Test may increase suspicion that shoulder girdle or costoclavicular positioning contributes to symptoms. It does not confirm TOS.
A negative test does not exclude TOS, especially when the client’s symptoms occur in different arm positions or with longer loading exposure.
Interpretation is stronger when combined with symptom history, vascular screen, neurological screen, cervical assessment, shoulder assessment, upper-limb neurodynamic testing and other TOS provocation tests.
High-quality 2020+ diagnostic accuracy values for the Eden Test alone were not identified. Current thoracic outlet research supports using a broader diagnostic pathway because TOS presentations are variable and provocation tests have limitations.
A 2022 study of a standardised elevated arm stress test found low discriminative value for neurogenic TOS diagnosis, reinforcing the need for caution with thoracic outlet provocation tests generally.
Reliability depends on posture, shoulder position, test duration, pulse palpation, symptom criteria and whether the client’s familiar symptoms are reproduced.
Because Eden Test protocols vary, the exact test posture should be documented for repeatability.
Common errors include using pulse change alone as positive, forcing posture, not recording symptoms, ignoring vascular warning signs, not documenting the exact posture and diagnosing TOS from a single test.
Limitations include false positives, non-specific symptoms, variable protocols and overlap with cervical radicular, peripheral nerve and shoulder conditions.
Use the Eden Test to document whether costoclavicular or shoulder girdle posture reproduces symptoms. It is most useful when combined with broader neurovascular, cervical and shoulder assessment.
Record test name, side tested, result, pain score, symptom location, symptom quality, posture used, shoulder position, duration, pulse response if monitored, neurological symptoms, vascular symptoms, dizziness, comparison side, confidence in result and reason for stopping.
Add related findings such as Adson’s, Halstead, Roos/EAST, Wright Test, cervical ROM, shoulder ROM, grip strength and neurodynamic testing.
Adson’s Test
Halstead Test
Roos Stress Test
Wright Test
Upper Limb Tension Test
Cervical ROM Tests
Shoulder ROM Tests
Grip Strength Test
It assesses whether costoclavicular or shoulder girdle positioning reproduces familiar upper-limb symptoms.
A positive finding is reproduction of familiar arm symptoms or vascular-type symptoms. Pulse change alone is not enough.
Yes, the terms are commonly used together, although exact protocols can vary.
No. It may support clinical reasoning but does not diagnose TOS on its own.
Record symptoms, posture, side, pulse response if monitored, duration and stopping reason.
The Eden Test assesses thoracic outlet symptom response in a costoclavicular posture.
Pulse change alone should not be treated as diagnostic.
TOS assessment requires broader clinical context.
The exact posture must be recorded.
Measurz should capture symptoms, posture, side and safety notes.
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.
