Eden’s test template

Key takeaways

Eden’s test screens for the costoclavicular form of thoracic outlet syndrome using a military brace posture.

A positive test reproduces the patient’s familiar arm symptoms, or diminishes the radial pulse, during the 60-second hold.

No validated sensitivity or specificity figures exist for this test, and pulse changes appear in most people without symptoms.

Treat the result as one input alongside Adson’s test, Wright’s test, the history, and imaging.

Practice management software like Pabau stores each result in the patient record, so repeat tests stay comparable over time.

Eden’s test is a provocation maneuver used to check whether the costoclavicular space is compressing the nerves and artery that feed the arm. It is one of three standard thoracic outlet syndrome (TOS) tests. This guide covers the procedure, how to read the result, and what the evidence supports. It also shows how the assessment fits into a digital documentation workflow.

Settle one thing up front. This test has no published sensitivity or specificity you can rely on. Pulse changes turn up in most healthy shoulders too. That shapes how much weight the result can carry, and how you word it in the notes.

What is Eden’s test?

Eden’s test, also called the costoclavicular or military brace test, compresses the neurovascular bundle between the clavicle and first rib. That channel is the costoclavicular space. Pulling the shoulders down and back narrows it. If compression there is causing the patient’s symptoms, the posture should reproduce them.

The structures at risk are the brachial plexus and the subclavian artery. Compression of either produces arm pain, paresthesia, weakness, or vascular changes such as coolness and swelling. Clinicians pair the test with Adson’s test and Wright’s test to narrow down where the compression sits.

Imaging can show an anatomical variant that never troubles the patient. A provocation test asks something narrower. Does this position bring the symptoms back?

Why the costoclavicular space matters

The costoclavicular space is a narrow channel bounded by the clavicle above, the first rib below, and the costoclavicular ligament. Two structures pass through it, and both are vulnerable when the channel narrows.

• Subclavian artery — the main blood supply to the arm, and the reason a positive test can change the radial pulse.
• Brachial plexus — the nerve bundle serving the arm, and the source of the pain, tingling, and weakness patients describe.

A military brace posture depresses and retracts both shoulders. That draws the clavicle and first rib closer together, narrowing the space. In a patient with TOS, that narrowing can be enough to reproduce symptoms or change the pulse. That is the response the test is looking for.

How to perform the test, step by step

Standardized performance is what makes the result comparable between clinicians and between visits. In physical therapy practices where several people run the test, agree on the protocol before anyone documents a finding.

1. Patient position: Seated or standing upright, arms relaxed at the sides, shoulders neutral.
2. Examiner instruction: Ask the patient to pull both shoulders backward and downward at the same time. Arms stay at the sides. The posture mimics standing at military attention.
3. Duration and monitoring: Hold for 60 seconds. Palpate the radial pulse on the side being tested throughout, and watch how the patient tolerates the position.
4. Symptom check: Ask whether the posture brings back their usual arm symptoms. Record the location and quality of anything reproduced.
5. Positive criteria: The test is positive if the patient’s familiar symptoms return. It also counts as positive if the radial pulse weakens or disappears during the hold.
6. Both sides: Repeat on the other arm. Comparing sides gives you more to work with than a single positive result.

What a positive result indicates

A positive Eden’s test points to compression in the costoclavicular space, and nothing more definite than that. It supports a TOS diagnosis when the history and the other provocation tests agree with it. On its own it does not confirm one.

Write down what was reproduced, where, how it felt, and how far into the hold it started. That detail is what makes the patient record useful on the next visit, and what a referral letter needs from you.

How accurate is Eden’s test?

No validated sensitivity or specificity figures exist for Eden’s test. A 2018 systematic review found little evidence supporting the validity of clinical tests for TOS. Heterogeneity across the admissible studies also stopped the authors pooling any results. Ranges quoted for this maneuver elsewhere do not trace back to a pooled analysis.

What is documented is how often the test turns positive in people who have no symptoms at all.

Those numbers say a positive pulse sign, on its own, tells you very little. Symptom reproduction is the finding worth acting on, because it links the position to the complaint the patient came in with.

So treat Eden’s test as a screen that tells you where to look next. Some provocation tests do carry published accuracy figures. The lateral pivot shift test is one, and knowing which category a test falls into changes how much weight you give it.

Comparing the three thoracic outlet provocation tests

Each of the three standard tests loads a different part of the thoracic outlet. Running all three tells you which compartment is most likely involved.

Positives on more than one test suggest either multifactorial TOS or a shoulder that simply reacts to position. Given how often healthy shoulders test positive, the second possibility deserves as much attention as the first.

When to run the test, and when to hold off

Run Eden’s test when a patient reports arm symptoms that come and go with position. Typical triggers are overhead work, carrying, and sleeping with the arm raised. It needs no equipment beyond your hands, so it costs a minute of the visit and nothing else.

Fold it into your standard upper-limb review rather than booking a separate visit. A 60-second hold on each side adds a couple of minutes, so most clinical appointments absorb it. Sports medicine practices see the presentation often, because overhead athletes load the thoracic outlet repeatedly.

• Good reasons to test: arm pain with overhead positioning, night-time tingling, progressive grip weakness, or temperature and swelling changes. Occupational arm symptoms in keyboard and overhead workers also qualify.
• Reasons to hold off: acute cervical or shoulder trauma, an unstable cervical spine, shoulder pain that blocks the position, or a recent clavicle fracture
• Not a reason to hold off: chronic pain, a previous TOS diagnosis, or established sensory loss

How to fill out the form

The template gives your team one place to write up a costoclavicular assessment. The sections are open text rather than tick boxes, so you decide how much detail each finding needs. Here is how the form maps onto the test.

1. Patient information: Name, age, gender, date of birth, and the date of assessment. Fill this in before you start.
2. Clinical notes: Chief complaint, medical history, and presenting symptoms. Occupational risk factors and any previous TOS diagnosis belong here.
3. Physical examination: Record your neurological and musculoskeletal findings first. Then use the military brace test box for the maneuver itself.
4. What goes in that box: The side tested, the 60-second hold, any symptom reproduction, and radial pulse status. The field is open text, so the level of detail is yours.
5. Imaging: Note imaging already on file or newly requested, and what it showed.
6. Interpretation: Use the recommendations field to state whether the test was positive or negative. Record next steps there too, such as further TOS tests, physical therapy, or a vascular referral.
7. Sign-off: Add your name, license number, signature, and date so the entry is attributable.

Because the fields are open text, agree on house wording for pulse status and symptom reproduction. Pulse diminished at 40 seconds carries information that pulse reduced does not. Settle that once and two clinicians’ entries stay comparable months apart.

Store the completed form in the patient’s record so the next assessment has a baseline to compare against. Let workflow automation handle the follow-up appointment.

Documenting findings in clinical software

Digital clinical documentation removes the step where a completed PDF has to be typed into the record. When assessment templates live inside the practice management system, each result attaches to the patient timeline on save. Referral summaries and outcome tracking then draw on the same entry.

• Structured data capture: positive or negative, pulse status, symptom location, and reproduction quality become searchable fields, which supports audit and outcome analysis
• Longitudinal tracking: serial results on one patient dashboard show whether treatment is changing the response
• Referral integration: export the assessment summary to a vascular surgeon, neurologist, or imaging center with the baseline findings attached
• Team consistency: a shared template enforces standardized procedure, which reduces clinician-to-clinician variation

Practices with several practitioners get the most out of a shared assessment library. Positional precision decides the result of this test, so everyone following the same protocol matters more here than for a range-of-motion measurement.

Conditions that mimic a positive result

Several conditions reproduce arm symptoms in the military brace position without any costoclavicular compression. Clinical context is what separates them.

• Cervical radiculopathy: neck position can trigger radicular pain, but the distribution follows a dermatome. A positive Spurling’s test and cervical MRI point to the nerve root instead.
• Shoulder impingement: overhead work reproduces pain, but it localizes subacromially rather than down the arm. Neer and Hawkins tests turn positive, and a positive drop arm test shifts suspicion to a cuff tear.
• Biceps tendon pathology: anterior shoulder and upper-arm pain overlaps with proximal TOS symptoms. A bicep tear test separates a tendon problem from neurovascular compression.
• Brachial plexus injury: symptoms do get reproduced, but the history is usually traumatic and one-sided. Imaging and EMG confirm nerve injury.
• Vascular disease: atherosclerosis and subclavian steal cause coolness and arm fatigue, often regardless of position. Ultrasound and angiography settle it.
• Other TOS forms: neurogenic, vascular, and disputed TOS present differently. Electrophysiology and imaging clarify which one you are dealing with.

Key point: weigh the whole picture before you commit to a TOS diagnosis. Symptom pattern, onset, functional limits, and imaging all count, and a single positive maneuver does not outweigh them.

How Pabau keeps provocation test notes comparable

Most practices run Eden’s test consistently and still end up with notes that do not line up. One clinician writes pulse diminished, the next writes pulse present but weak. Neither entry records how far into the hold the change appeared.

Pabau closes that off with a form the whole team fills in the same way. You build the Eden’s test write-up once as a digital form, with the fields your protocol calls for. Every completed assessment saves straight to the patient record, timestamped and attributed.

The outcome is a set of results you can line up side by side. Repeat the test after six weeks of therapy and the change is visible on the timeline, not buried in free text. Automated follow-up reminders bring the patient back for that second measurement.

Keep every assessment in one patient record

Pabau builds your Eden's test write-up into a digital form that saves straight to the patient record. Follow-up reminders go out automatically, so the repeat measurement does not get missed.

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Conclusion

Eden’s test earns its place because it is quick, needs no equipment, and points you toward the right compartment. What it cannot do is confirm TOS on its own. Pulse changes are too common in healthy shoulders for that.

So use it as a screen, run Adson’s and Wright’s alongside it, and let symptom reproduction carry more weight than the pulse. Then write it up in wording your colleagues will read the same way you meant it.

Standardized procedure and consistent documentation are what turn a rough screen into something you can track over time. Book a demo to see how Pabau keeps assessment templates and results together in one patient record.

Continue your research

Need the interscalene equivalent? Adson’s test template covers positioning, pulse monitoring, and how to record the result.

Want a third TOS provocation test? Halstead maneuver explains the technique and what a positive finding suggests.

Suspect a nerve-tension component? Upper limb tension tests sets out each variant and its target nerve.

Checking first-rib mobility? Cervical rotation lateral flexion test shows how to assess the first rib on each side.

Writing the assessment up afterwards? SOAP progress notes template shows where a provocative test result belongs.

Frequently asked questions