Adson's Test: Assessing Thoracic Outlet Syndrome (TOS)

If a client describes tingling, weakness, or heaviness in the arm that gets worse with certain neck and shoulder positions (for example, when raising the arms overhead), it's worth considering thoracic outlet syndrome (TOS). Adson's test is one of the classic screening tests for this condition, focused on compression of the neurovascular bundle at the scalene muscles.

What does this test measure?

Adson's test checks for compression of the subclavian artery (and, by extension, the nearby brachial plexus) between the anterior and middle scalene muscles, by creating a position that narrows that space: cervical rotation and extension toward the side being tested, combined with a deep breath.

It's based on detecting changes in the radial pulse and the appearance of symptoms during the maneuver.

Equipment needed

• Nothing essential
• Optional: a pulse oximeter if you want to track oxygen saturation, though this isn't standard for the classic test

Test protocol

1. The client sits with their back straight
2. Locate and palpate the radial pulse at the wrist on the side being tested
3. Ask the client to extend the neck and rotate the head toward the same side you're testing
4. Ask them to take a deep breath and hold it
5. While they hold that position, check whether the radial pulse decreases or disappears
6. Ask whether any symptoms appear (tingling, pain, the arm "falling asleep") during the maneuver
7. Repeat on the other side for comparison

Common mistakes

• Not properly palpating the radial pulse before starting (without a baseline, you can't assess the change)
• Mistaking normal pulse variations — which can occur in healthy people — for a positive test, without considering associated symptoms
• Not comparing both sides

How to interpret the results

Result	Interpretation
Positive: decreased/absent radial pulse along with reproduction of symptoms (tingling, pain)	Suggests thoracic outlet compression on the tested side — points toward TOS
Pulse change without symptoms	Low-specificity finding — can occur in asymptomatic people; consider alongside other TOS tests
Negative: no significant pulse change or symptoms	Doesn't rule out TOS on its own, but lowers suspicion at that point

Adson's test has limited specificity when used in isolation, so it should always be interpreted alongside the clinical history (positional symptoms, occupation, overhead sports) and, if there's significant suspicion, referred for specialized medical evaluation.

Related tests

Adson's test is part of a battery of tests for TOS and relates to:

• Cervical distraction test — useful for distinguishing cervical radicular pain from a TOS presentation
• Cervical compression test (Spurling's) — to rule out an associated cervical radicular component

Tracking with Movalytics

If you work with clients who train in overhead positions (swimmers, throwing sports, weightlifting) and present with TOS symptoms, it's useful to document which positions trigger them and how they evolve. With Movalytics you can log the Adson's test result at each assessment along with reported symptoms, and track whether training modifications are helping.

FAQ

Is Adson's test painful? It shouldn't cause significant pain; the typical sensation is tingling or heaviness if there's compression, along with the pulse change. Does a positive result mean TOS is confirmed? No, it's a screening test with low specificity on its own. A positive result, combined with a compatible clinical picture, warrants a more thorough evaluation. Can Adson's test give "false positives" in healthy people? Yes, mild radial pulse changes during this maneuver can occur in people without pathology, which is why clinical context is key.