Thallium stress test: What it shows, procedure, and results
Chest pain with a normal ECG leaves a cardiologist holding a decision and very l...
Last Updated: August 10, 2026
Key takeaways
The Wright test screens for thoracic outlet syndrome by passively lifting the arm into full overhead abduction.
Hyperabduction pulls the pectoralis minor tendon taut over the coracoid process and squeezes the nerves and artery beneath it.
Treat symptom reproduction as the primary positive sign, because a fading radial pulse also appears in plenty of healthy arms.
A negative result rules out very little, since the test challenges only one of the three compression zones.
Record the angle where symptoms began and the result on the other arm, or the finding cannot be read again later.
The Wright test, also called the hyperabduction test, moves the patient’s arm passively into full overhead abduction. While the arm travels, you watch for two signs. One is the return of the patient’s familiar symptoms. The other is a radial pulse that fades at the wrist.
The reason sits in the anatomy. Raise the arm high enough and the pectoralis minor tendon pulls taut across the coracoid process. The space beneath it narrows, and the brachial plexus and axillary artery take the squeeze.
That single mechanism explains the rest of this article, including why a negative test proves so little about thoracic outlet syndrome elsewhere in the outlet.
Three compression zones, three different provocative tests
Three separate spaces between the neck and the armpit can pinch the neurovascular bundle. Each space has its own provocative test. That is why the anatomy tells you which tests to combine, rather than which single test to trust.
The Wright test challenges the third of those spaces. As the arm passes 90 degrees and heads toward 180, the pectoralis minor tendon stretches over the coracoid process.
In a patient with genuine subcoracoid compression, that narrowing is enough to bring the symptoms back. Whether you see that response, though, depends on how you move the arm.
How to perform the Wright test so the result means something
Seat the patient, find the radial pulse, then lift the arm passively into full abduction and hold it there. Small variations in position, speed, or hand placement make results impossible to compare, either between sides or between visits.
Screen shoulder movement first as well. If end-range abduction is already painful or restricted, a range of motion assessment tells you more than a provocative test will.
Run the seven steps in this order
- Position the patient: Sit them upright, away from any back support. Both arms rest relaxed at their sides. Ask for normal, quiet breathing.
- Take a baseline pulse: Palpate the radial pulse on the test side before anything moves. Note how strong it feels. That is your reference point.
- Lift the arm passively: Support the elbow and the wrist. Move the arm slowly through the coronal plane, past 90 degrees, toward full overhead abduction near 180 degrees. The patient stays passive throughout.
- Monitor the whole arc: Keep a finger on the pulse. Ask the patient to report any change in sensation, pain, or their usual complaint, and note the angle where it starts.
- Hold at end range: Stay in hyperabduction for 30 to 60 seconds if the patient tolerates it. Sustained compression provokes a vascular response that a quick sweep misses.
- Repeat on the other arm: Pulse changes turn up in healthy limbs too, so the unaffected side gives you the context to judge the finding.
- Write it down straight away: Capture the angle, the symptoms, and the side-to-side difference before you move on to the next test.
Two slips cause most of the damage. Letting the patient assist the movement changes the muscle tension around the outlet, which can hide a finding or manufacture one.
Moving too fast is the other, since the artery gets no time to respond. With a clean response in hand, the interpretation starts.
In a positive Wright test, symptoms outrank the pulse
A positive Wright test means one of two things happened during hyperabduction:
- Symptom reproduction: the patient reports the familiar pain, paresthesia, numbness, or heaviness that brought them in. That points to the brachial plexus being compressed under the pectoralis minor.
- Radial pulse diminution or loss: the pulse weakens or disappears at the wrist during hyperabduction. That points to the axillary artery, compressed in the same subcoracoid space.
What a positive result changes in your plan
A positive result tells you where to look next, and little more. Neurogenic findings point toward nerve conduction studies and a neurology opinion. Vascular findings point toward duplex ultrasound or a vascular surgery referral.
One question sharpens the reading: is this the pain the patient came in with? Exact reproduction of the presenting pattern carries weight, while a brand-new sensation at end range usually does not.
An example helps. A 34-year-old swimmer reports numbness in the ulnar two fingers after overhead sets. At roughly 150 degrees on the right, the numbness returns while the pulse stays strong. The left arm reaches full abduction with nothing at all.
That asymmetry, paired with a familiar complaint, is a useful neurogenic finding. It also disappears entirely if the note says only that the Wright test was positive.
Why a negative result rules out less than you think
A negative Wright test does not clear the patient. It challenges the subcoracoid space and nothing else.
Compression in the interscalene triangle or the costoclavicular space usually leaves this test negative while Adson’s or Eden’s test turns positive. That is the argument for running a battery instead of one favorite maneuver.
The weak spot of the Wright test is specificity
Accuracy figures for this test are contested, so quote them with the study in hand. Published sensitivity estimates sit in the range of 70-90%, depending on the population studied and the definition of a positive test. Specificity runs considerably lower, often below 60%.
The reason is well documented. Rayan and Jensen found radial pulse obliteration in a large share of asymptomatic volunteers during hyperabduction.
More recent systematic reviews keep making the same point. Pulse obliteration on its own is an unreliable positive sign without symptom reproduction alongside it.
So treat symptom reproduction as the primary criterion. A lost pulse with no symptoms is weak evidence, particularly when the other arm behaves the same way.
Few provocative tests score well on both measures at once. The crossed straight leg raise sits at the opposite end, with tight specificity and modest sensitivity.
Wright, Adson’s, and Roos each squeeze a different spot
No single TOS test carries enough sensitivity and specificity to stand alone. The usual approach combines tests that target different zones, then reads the results against the symptom history, the neurological examination, and imaging.
Knowing what each maneuver stresses is what lets you pick the right combination for the presentation in front of you.
For most patients, Wright plus Roos plus Adson’s covers all three zones. Agreement across several tests raises confidence far more than any single positive ever will.
That is the same logic behind clinical decision rules, which turn a set of individual findings into one defensible next step.
Pro Tip
Run the test on both arms before you conclude anything. Radial pulse loss during hyperabduction turns up in plenty of healthy adults. A one-sided finding that reproduces the patient’s own symptoms carries far more weight. Bilateral pulse changes with no symptoms carry very little. Note the angle on each side, since a clear asymmetry says more than the finding alone.
The mistakes that turn a healthy arm into a positive test
Most false positives come from technique and interpretation, not from the patient. Run through this list before you commit a finding to the record.
- Trusting the pulse: radial pulse obliteration during hyperabduction has been reported in 60-80% of healthy, asymptomatic volunteers. Symptom reproduction is the finding that carries clinical meaning.
- Forgetting the other zones: this test only challenges the subcoracoid space. A patient with scalene or costoclavicular compression will often test negative, so pair it with Adson’s and Eden’s tests.
- Letting the patient help: active elevation changes the muscular dynamics around the outlet. The maneuver stays passive from start to finish.
- Rushing the arc: a fast lift shortens the compression time and can miss a vascular response that needs 30 seconds or more to appear.
- Skipping the other arm: without a contralateral reference, a pulse or symptom finding cannot be interpreted. Test both sides and record the comparison.
- Blaming the outlet for shoulder pain: end-range abduction is uncomfortable for plenty of reasons. Labral and scapulothoracic problems mimic outlet symptoms, so keep the clunk test in the differential.
- Treating red flags as findings to monitor: intrinsic hand muscle wasting, progressive neurological deficit, Horner’s syndrome, and a supraclavicular mass all need urgent referral. Document that escalation as part of your medical decision making.
Roos (EAST) is generally treated as the most sensitive test of the group, which makes it the better rule-out when suspicion is high. The Wright test earns its keep inside a battery, and only when the finding is written down clearly enough to compare at the next visit.
What a usable Wright test note looks like in practice
A provocative test earns its value at the follow-up, when someone needs to know whether the picture has changed. On paper, that comparison is usually lost.
Most physical therapy teams already run some form of practice management software. The assessment itself, though, still lands on a printed form that gets filed and forgotten.
Five details that make the finding comparable
- The angle at which symptoms or pulse changes appeared.
- Which sign appeared, and whether the symptoms were the patient’s familiar ones.
- The result on the other arm, recorded side by side.
- The other zone tests you ran, and what each of them showed.
- The decision that followed, including any referral and its reason.
Structured digital records keep those five details together. Practice management software like Pabau stores them in the client record as a SOAP note, tied to the appointment and the treatment plan.
The next visit then opens with the last result already in view. If you want a model to copy, these SOAP note examples show the shape. For the habits that keep a record defensible, read safer clinical notes.
Intake matters as much as the test. Symptom history, aggravating postures, and occupation all shape how you read a positive result. Digital intake forms gather that before the appointment.
You then start the assessment with the story already in front of you, instead of spending ten minutes building it. A physical therapy intake form is a reasonable starting template.
Dictation closes the last gap between the assessment and the record. Pabau Scribe, our AI scribe, turns the spoken examination into a structured note. The angle and the side-to-side comparison land in the client record while they are still fresh.
Physical therapy teams and sports medicine teams want the same two things from a record here. They want findings they can compare over time, and a referral trail that holds up when someone reviews the case months later.
Keep every TOS assessment comparable
Pabau stores Wright test findings in a structured SOAP note beside the client's history, forms, and referrals. The next visit opens with the last result already in view.
Conclusion
The Wright test is a fast, no-cost way to ask whether the subcoracoid space is part of the problem. Used alone, it will hand you false positives. Inside a battery, with a passive lift, a held end range, and a bilateral comparison, it earns its place in the examination.
The discipline lives in the reading. Weigh symptom reproduction above a fading pulse, and write down enough detail that a colleague could repeat exactly what you did.
If those notes still live on paper forms, that is where the value leaks out. Book a demo to see how Pabau keeps clinical findings, intake forms, and referrals together in one client record.
Continue your research
Recording shoulder movement before you provoke it? Shoulder range of motion template gives you a printable grid for baseline and follow-up figures.
Need sharper sensory testing for neurogenic findings? Two-point discrimination test explains how to grade and record light-touch changes in the hand.
Assessing a painful wrist after a fall? Scaphoid fracture test walks through the examination sequence and when imaging becomes necessary.
Following up an anterior elbow dislocation? S53.116D covers the documentation a subsequent encounter needs.
Charting a thoracic fracture that has not united? S22.049K sets out what belongs in the encounter note.
Frequently asked questions
Who is the Wright test named after?
Irving Wright, the American physician who described hyperabduction syndrome in 1945. His original series showed that lifting the arms overhead could obliterate the radial pulse in healthy people too. That finding is why the modern test leans on symptom reproduction rather than the pulse alone.
When should you skip the test?
Skip or delay it whenever end-range abduction is unsafe. A recent shoulder dislocation, an unhealed fracture, marked instability, and severe acute radicular pain are all reasons to wait. Stop early if symptoms escalate sharply, and record why the test was not completed.
Do you need any equipment?
No. Your fingers on the radial pulse and a chair are enough. Some clinicians add a pulse oximeter or a handheld Doppler, so the vascular change is recorded as a number rather than an impression.
What treatment usually follows a positive result?
Conservative care comes first for most patients. That means postural retraining, lengthening the pectoralis minor, and rebuilding scapular and thoracic mobility, alongside changes to aggravating activity. Vascular signs, muscle wasting, or symptoms that keep progressing warrant a surgical opinion instead.
Is a positive result the same as pectoralis minor syndrome?
Not quite. Compression under the pectoralis minor is sometimes described as pectoralis minor syndrome, and it often sits alongside neurogenic TOS. A positive hyperabduction finding raises that possibility. Confirming it takes the symptom history, the rest of the examination, and further investigation.
