Adson’s test template and usage guide

Key Takeaways

Adson’s test is a provocative maneuver used to detect thoracic outlet syndrome by assessing subclavian artery compression.

High sensitivity (72-92%) but low specificity (9-53%) means it screens for TOS risk but cannot confirm diagnosis alone.

Combining Adson’s test with related maneuvers (Roos, Wright’s, Costoclavicular) and clinical history improves diagnostic accuracy.

Pabau’s digital forms and clinical record tools help physiotherapists document test findings and track vascular/neurogenic TOS patterns systematically.

Adson’s test is a clinical assessment maneuver used by physiotherapists, chiropractors, and sports medicine clinicians to screen for thoracic outlet syndrome (TOS) – a condition where nerves or blood vessels become compressed in the space between the collarbone and first rib.

The test involves palpating the radial pulse while the patient assumes a specific neck and arm position, then observing whether the pulse diminishes or disappears. A positive result suggests potential subclavian artery or brachial plexus compression, warranting further investigation with imaging and additional provocative maneuvers.

This clinical assessment template and reference guide covers the procedure step-by-step, interpretation criteria, sensitivity and specificity data from peer-reviewed research, and documentation fields for integrating findings into your practice workflow. Whether you document on paper or digitally, this guide ensures consistent, thorough TOS screening and helps clinicians differentiate between vascular and neurogenic presentations.

What is Adson’s test?

Adson’s test is a provocative maneuver designed to temporarily narrow the interscalene triangle-the anatomical space bounded by the anterior and middle scalene muscles-and assess whether this compression affects blood flow through the subclavian artery or irritates the brachial plexus.

The test is named after Alfred Washington Adson, a pioneering neurosurgeon who first described it in 1927 as a clinical screening tool for TOS.

TOS encompasses three main types: vascular TOS (subclavian artery or vein compression), neurogenic TOS (brachial plexus compression), and disputed TOS (symptoms without objective vascular or neurological findings). Adson’s test primarily detects vascular TOS, though symptom reproduction (arm pain, tingling, or heaviness) may suggest neurogenic involvement.

The test is quick, non-invasive, and requires no special equipment-only the ability to palpate the radial pulse and guide the patient through a standardized position.

How to perform Adson’s test: Step-by-step procedure

Performing Adson’s test accurately requires attention to patient positioning, pulse palpation technique, and recognition of positive findings. The following steps ensure reproducible, clinically valid results.

1. Patient positioning: Seat the patient upright in a chair with feet flat on the floor and arms at their sides. Ensure they are relaxed and breathing normally.
2. Locate the radial pulse: Palpate the radial pulse on the affected side using your index and middle fingers. Note the pulse strength and rhythm before the maneuver begins.
3. Neck extension and rotation: Ask the patient to extend their neck slightly and turn their head towards the side being tested (ipsilateral rotation). This position tightens the scalene muscles and narrows the interscalene triangle.
4. Shoulder depression: While maintaining the head position, the patient should slightly retract and depress the shoulder on the tested side (posterior and downward movement). This further reduces space in the thoracic outlet.
5. Deep inhalation (optional Valsalva component): Some clinicians ask the patient to take a deep breath and hold it briefly. This increases intrathoracic pressure and may enhance compression.
6. Monitor the radial pulse: Continue palpating the radial pulse throughout the maneuver. Hold the test position for 30-60 seconds while observing pulse changes.
7. Record findings: Document whether the pulse remained strong, diminished, or disappeared completely. Note any symptoms the patient reports (arm fatigue, tingling, pain, or heaviness).
8. Release and reassess: Return the patient to a neutral position and confirm the radial pulse returns to baseline strength.

Positive test result: Obliteration or significant diminution of the radial pulse, especially when accompanied by reproduction of the patient’s symptoms (arm pain, numbness, or heaviness), suggests positive findings. A positive pulse change alone, without symptom reproduction, is less clinically meaningful.

Sensitivity, specificity, and clinical utility

Understanding Adson’s test diagnostic accuracy helps clinicians interpret findings correctly and avoid over-reliance on a single screening tool.

Research published in PubMed Central shows that Adson’s test sensitivity ranged from 72% to 92%, while specificity was consistently low at 9-53%. This pattern-high sensitivity, low specificity-means the test is effective at identifying individuals at risk for TOS but cannot confirm the diagnosis on its own.

False positives are common in healthy volunteers and in patients with overlapping upper limb disorders such as carpal tunnel syndrome.

Predictive value improves significantly when Adson’s test is combined with other provocative maneuvers and when patients have confirmed cervical ribs (a structural risk factor for compression). Digital assessment forms that track multiple test results side-by-side help clinicians build a comprehensive TOS workup profile.

Who uses Adson’s test assessment forms?

This assessment template is designed for healthcare professionals who evaluate upper extremity complaints and screen for thoracic outlet syndrome as part of their clinical practice.

• Physiotherapists and physical therapists conducting upper limb and cervical spine assessments in both primary care and specialist settings, often starting with a standard physical therapy intake form.
• Chiropractors performing cervical and upper extremity adjustments who need to screen for neurovascular involvement before treatment and record findings in a chiropractic SOAP note.
• Sports medicine clinicians and physicians evaluating athletes with arm pain, numbness, or fatigue related to overhead activities.
• Occupational therapists assessing functional limitations in patients with hand or arm symptoms, frequently alongside a shoulder range of motion chart.
• Nurse practitioners and physician assistants in urgent care and primary care settings conducting initial TOS screening.

Benefits of using Adson’s test documentation

Standardized assessment: A structured form ensures every Adson’s test is performed the same way and documented consistently, reducing variation between clinicians and improving data comparability over time.

Compliance and audit readiness: Physiotherapy and chiropractic practices face strict documentation requirements under state licensing board and professional practice standards. A standardized Adson’s test form demonstrates that your practice follows evidence-based assessment protocols and maintains thorough records for audit and complaint investigation.

Diagnostic confidence: By documenting radial pulse findings, symptom reproduction, and any related maneuvers performed in the same assessment session, you build a complete clinical picture that supports referral decisions, treatment planning, and billing for follow-up physical therapy re-evaluation.

Patient communication: A clear, signed consent form and assessment record demonstrate informed decision-making and provide the patient with a copy of their findings-improving transparency and reducing misunderstanding about why further imaging or specialist referral is recommended.

Integration with AI-assisted clinical documentation: Practices using modern EMR systems can input Adson’s test findings into structured records that automatically generate summary notes, similar to how AI SOAP note tools convert visit findings into billable documentation, reducing administrative burden and improving accuracy.

Adson’s test vs. related TOS provocative maneuvers

No single test can diagnose thoracic outlet syndrome. Clinicians typically use multiple provocative maneuvers to increase confidence. Understanding how Adson’s test compares to related tests helps guide your assessment strategy.

• Roos Test (Elevated Arm Stress Test, EAST): Patient holds arms abducted 90° with elbows bent 90°, then opens and closes fists for 3 minutes. Positive if hands become pale or symptom reproduction occurs. Tests for vascular TOS; often more sensitive than Adson’s for patients with dynamic (activity-related) compression.
• Wright’s Test (Hyperabduction Test): Patient abducts and externally rotates the affected shoulder to 180°. Examiner palpates radial pulse. Positive if pulse diminishes or symptoms appear. Focuses on compression at the pectoralis minor level; useful when scalene compression is ruled out.
• Costoclavicular Test (Eden’s Test): Patient retracts and depresses the shoulder while maintaining arm at side. Examiner monitors radial pulse. Tests for first-rib compression and anterior scalene tightness. Often performed together with Adson’s test to improve specificity.
• Reverse Adson’s Test: Patient extends the arm behind the body and turns the head away from the tested side (opposite direction from standard Adson’s). Assesses for TOS in patients with unusual anatomical variation or symptom patterns.

Research supports using clinical documentation software that guides clinicians through all relevant tests in sequence, scoring and comparing results. Combined testing protocols yield higher diagnostic confidence than any single maneuver.

Clinical documentation best practices

Clinical documentation best practices for Adson’s test follow the same SOAP note structure used elsewhere in the chart, focusing on precision, consistency, and medico-legal clarity. Key fields to include:

• Patient positioning: Note exact head position (rotation direction and degree), shoulder position (depressed/elevated), and whether deep breathing or Valsalva was used.
• Radial pulse baseline: Document pulse strength and rhythm BEFORE the test (e.g. “strong, regular, palpable at wrist”).
• Radial pulse during test: Describe changes observed (e.g. “pulse obliterated during maneuver,” “diminished but palpable,” “unchanged”).
• Symptom reproduction: Record whether the patient experienced their familiar symptoms (arm pain, numbness, heaviness, tingling, color change) during the test.
• Test classification: State whether findings are consistent with vascular TOS (pulse change) or neurogenic TOS (symptom reproduction without pulse change) or both.
• Associated tests performed: List which other maneuvers (Roos, Wright’s, Costoclavicular, Halstead) were performed in the same session and their results.
• Interpretation and plan: Document whether results support further imaging (MRI, CT, ultrasound, angiography) or specialist referral.
• Patient education: Note if the patient was counseled about findings and next steps.

Structured client records in modern EMR systems make this documentation faster and more standardized. Practices that implement digital assessment templates report improved compliance with documentation standards and faster specialist referral turnaround.

Vascular vs. neurogenic TOS: Interpretation clarity

Adson’s test findings help differentiate between the two main TOS presentations. Understanding this distinction guides referral pathways and treatment decisions.

• Vascular TOS: Positive Adson’s test (radial pulse diminishes or disappears) suggests subclavian artery or vein compression. Patients often report arm fatigue, color changes (pallor or cyanosis), swelling, or coolness in the hand. Requires vascular imaging (ultrasound, MRA, or CT angiography) and often benefits from physical therapy to improve posture and reduce muscle tension.
• Neurogenic TOS: Symptom reproduction (arm pain, tingling, numbness) WITHOUT pulse change suggests brachial plexus compression. More common than vascular TOS. Requires nerve imaging (MRI, EMG/NCS) and structured rehabilitation. Some patients have “pain-only” TOS with no objective findings-controversial diagnosis requiring careful exclusion of carpal tunnel syndrome and cervical radiculopathy.
• Combined presentation: Some patients show both pulse diminution AND symptom reproduction, indicating both vascular and neurogenic involvement. These cases often benefit from multidisciplinary assessment and more aggressive intervention.

Documentation forms that distinguish these presentations help sports medicine clinicians and physiotherapists communicate clearly with referring physicians and specialists about the anatomical basis of symptoms.

Conclusion

Adson’s test remains a cornerstone screening tool for thoracic outlet syndrome in physiotherapy, chiropractic, and sports medicine practice. Its high sensitivity (72-92%) makes it effective for identifying individuals at risk, while its low specificity underscores the need for combined testing, imaging, and specialist referral to confirm diagnosis.

Using a standardized assessment form-especially one integrated into your EMR-ensures consistent, thorough documentation that supports clinical decision-making and meets professional compliance standards.

A structured approach to Adson’s test and related provocative maneuvers, supported by Pabau’s digital forms and clinical record tools, helps your practice screen for TOS confidently, differentiate vascular from neurogenic presentations, and refer patients appropriately to imaging or specialist care. Book a demo to see Pabau in action.

Continue your research

Need structured guidance on upper limb assessment protocols? Physical therapy EMR software helps physiotherapists organize and compare multiple provocative tests within a single patient record.

Want to improve your clinical documentation consistency? Digital forms for healthcare practices ensure every Adson’s test is documented the same way across your practice.

Looking to streamline TOS referral workflows? Automated workflow software can trigger specialist referral prompts when multiple TOS maneuvers are positive.

Frequently asked questions