The Eden Test, also known as the Costoclavicular Test or Military Brace Test, is a thoracic outlet provocation test used to observe whether shoulder girdle positioning reproduces familiar upper-limb symptoms. It is commonly used to stress the costoclavicular space between the clavicle and first rib. A positive test may include reproduction of familiar arm symptoms, paraesthesia, heaviness, vascular-type symptoms or a marked pulse change with symptoms. The test does not confirm thoracic outlet syndrome on its own and should be interpreted with history, vascular screening, neurological screening and other thoracic outlet findings.

Introduction

Thoracic outlet syndrome assessment is complex because neck, shoulder, brachial plexus, vascular and peripheral nerve presentations can overlap. The Eden Test is one of several provocative tests used to explore whether a specific shoulder girdle position reproduces symptoms that may be associated with thoracic outlet loading.

The test is commonly described as stressing the costoclavicular space, the area between the clavicle and first rib where neurovascular structures pass toward the upper limb. During the test, the client’s shoulders are drawn downward and backward, similar to a military brace posture, while symptoms and sometimes radial pulse response are monitored.

Interpretation should be cautious. A positive Eden Test may support thoracic outlet assessment reasoning, especially when familiar symptoms are reproduced, but it does not diagnose thoracic outlet syndrome or identify the exact structure involved. The test is most useful when recorded clearly and interpreted with a broader assessment.

Quick Summary

Test name: Eden Test
Also known as: Eden’s Test, Costoclavicular Test, Military Brace Test
Body region: Thoracic outlet, costoclavicular space, shoulder girdle and upper limb
Purpose: Assess symptom response to costoclavicular-style thoracic outlet loading
Commonly associated with: Thoracic outlet syndrome assessment and upper-limb neurovascular symptom screening
Positive finding: Reproduction of familiar upper-limb symptoms, vascular-type symptoms or marked pulse change with symptoms
Negative finding: No familiar symptom reproduction and no concerning vascular or neurological response
Best used with: Adson’s Test, Halstead Test, Roos Stress Test, Wright Test, cervical assessment, shoulder assessment, neurological screen and vascular screen
Key limitation: Eden’s Test does not confirm thoracic outlet syndrome on its own.

What Is the Eden Test?

The Eden Test is a thoracic outlet provocation assessment used to observe symptom response when the shoulder girdle is positioned to stress the costoclavicular region. The client usually sits or stands upright while the professional guides the shoulders into a depressed and retracted position.

This position may reduce the available space between the clavicle and first rib and can provoke symptoms in some people with thoracic outlet-related presentations. However, the test does not isolate one structure. Symptoms may also arise from cervical radicular symptoms, peripheral nerve sensitivity, shoulder girdle loading, vascular sensitivity, muscular tension or general symptom irritability.

Why It Is Used

The Eden Test is used when thoracic outlet involvement is being considered as part of a broader assessment. It may be relevant when a client reports upper-limb heaviness, paraesthesia, numbness, coldness, colour change, hand fatigue, symptoms with backpack use, symptoms with load carriage or symptoms influenced by posture.

The test can help determine whether further thoracic outlet assessment, neurological screening, vascular screening, cervical assessment or shoulder assessment should be explored. It should not be used in isolation to label a condition.

What It Assesses

The Eden Test assesses:

• Symptom response to costoclavicular-style shoulder girdle positioning
• Upper-limb paraesthesia, heaviness or fatigue response
• Vascular-type symptom behaviour
• Radial pulse response, if monitored
• Symptom change with shoulder depression and retraction
• Safety and tolerance to thoracic outlet loading
• Whether the symptoms reproduced are familiar to the client

It does not directly diagnose neurogenic, venous or arterial thoracic outlet syndrome.

Who It Is Useful For

The test may be useful for clients with upper-limb symptoms that appear influenced by posture, load carriage, backpack use, shoulder girdle depression, prolonged standing, overhead activity or sustained arm positions.

It may also be useful in education settings where professionals are learning thoracic outlet assessment and neurovascular symptom documentation. It should be used cautiously when vascular symptoms are prominent, when symptoms are severe or when red flags are present.

When to Use This Test

Use the Eden Test when:

• Thoracic outlet involvement is part of the assessment reasoning
• The client has upper-limb symptoms influenced by posture or shoulder position
• The client can tolerate shoulder girdle depression and retraction
• You can monitor symptom behaviour carefully
• You can screen for concerning vascular or neurological signs
• The result will be interpreted with related tests and history

When Not to Use or When to Be Cautious

Use caution or avoid the test when there is unexplained arm swelling, colour change, marked temperature change, suspected vascular compromise, suspected clotting, faintness, dizziness, severe neurological deficit, acute trauma, cervical instability concern, known vascular disease, severe cervical pain or symptoms requiring urgent medical review.

Stop immediately if dizziness, faintness, colour change, coldness, severe paraesthesia, worsening neurological symptoms, concerning pulse change with symptoms or client distress occurs.

Equipment Required

The Eden Test requires minimal equipment:

• Chair or safe standing space
• Pain and symptom rating scale
• Symptom-location recording method
• Optional pulse monitoring
• Measurz app for structured documentation
• Optional video for posture and setup review
• Optional MAT notes for cervical, shoulder and neurovascular findings

Within Measurz, the Eden Test can be recorded alongside Adson’s Test, Halstead Test, Wright Test, Roos Stress Test, cervical ROM, shoulder ROM, upper-limb neurodynamic testing, neurological screening and grip strength. Measurz helps capture posture, symptom response, pulse change, safety findings and related test results.

Step-by-Step Protocol / Practice

Setup

Explain that the test places the shoulders and upper chest in a posture that may reproduce arm symptoms. Ask the client to report symptoms immediately, including tingling, numbness, heaviness, coldness, colour change, dizziness or familiar arm symptoms.

Record baseline symptoms before testing, including pain score, symptom location, hand temperature or colour concerns and any current neurological or vascular-type symptoms.

Client position

The client sits or stands upright. Sitting is often preferred for safety and consistency, especially if symptoms are irritable.

Examiner/professional position

Stand behind or beside the client. If pulse monitoring is included, locate the radial pulse before positioning begins.

Hand placement

One hand may monitor the radial pulse at the wrist. The other hand may guide the shoulders into depression and retraction, or both hands may be used to position the shoulder girdle if pulse monitoring is not used.

Stabilisation

The client should remain upright and relaxed. Avoid excessive spinal extension or aggressive shoulder positioning.

Movement or force direction

A common sequence is:

1. Locate the radial pulse if pulse monitoring is being used.
2. Ask the client to sit or stand tall.
3. Guide the shoulders backward and downward into a military brace posture.
4. Some protocols ask the client to gently lift the chest while maintaining the shoulder position.
5. Monitor symptoms and pulse response for a short, controlled period.
6. Return to neutral and compare with the other side if appropriate.

Instructions

Ask:

“Tell me immediately if you feel tingling, numbness, heaviness, coldness, dizziness or familiar symptoms.”
“Tell me if your symptoms change, spread or become stronger.”
“Tell me if your hand feels cold, heavy or different.”
“Let me know if this feels unsafe or uncomfortable.”

Positive finding

A positive finding is reproduction of familiar upper-limb neurological or vascular-type symptoms during the test position. A marked radial pulse change may be recorded, but pulse change alone should not be used as the only positive criterion.

Negative finding

A negative finding is no familiar symptom reproduction and no concerning vascular or neurological response during the test.

Stopping criteria

Stop if symptoms increase sharply, dizziness occurs, colour change appears, the hand becomes cold, paraesthesia increases significantly, neurological symptoms worsen, pulse concerns occur with symptoms or the client feels unwell.

Safety notes

Do not use aggressive shoulder depression or retraction. Do not hold the test position longer than necessary. Prioritise familiar symptom reproduction and safety over pulse findings alone.

Positive and Negative Test Interpretation

A positive Eden Test may increase suspicion that costoclavicular or thoracic outlet loading is relevant when it reproduces familiar upper-limb neurological or vascular-type symptoms. It is more meaningful when the response matches the client’s history and is supported by other thoracic outlet, neurological or vascular findings.

A positive result does not confirm thoracic outlet syndrome or identify whether symptoms are neurogenic, venous or arterial. Symptoms may also be influenced by cervical radicular symptoms, peripheral nerve sensitivity, shoulder girdle loading, scalene or pectoral sensitivity, anxiety, vascular sensitivity or general irritability.

A negative Eden Test means the tested position did not reproduce familiar symptoms or a concerning vascular response. This does not exclude thoracic outlet involvement, especially if symptoms occur only during overhead tasks, carrying loads, prolonged postures or specific sport or work positions.

Sensitivity, Specificity and Diagnostic Accuracy

Diagnostic accuracy for thoracic outlet provocative tests is variable and should be interpreted cautiously. Eden-specific diagnostic accuracy values are less consistently reported than some other TOS tests, and studies often use different reference standards.

Gillard et al. evaluated provocative testing as part of a broader thoracic outlet assessment in people with suspected thoracic outlet syndrome. Their work supports the general principle that no single provocative test is confirmatory and that clinical findings should be interpreted alongside investigations and exclusion of other causes.

Systematic review evidence on neurogenic and vascular thoracic outlet syndrome has highlighted heterogeneous methods, variable diagnostic criteria and limited certainty around clinical test accuracy. This means the Eden Test should be interpreted as a symptom provocation and screening tool rather than as a stand-alone diagnostic accuracy test.

Reliability and Validity

Reliability may be affected by differences in shoulder depression force, shoulder retraction, posture, test duration, pulse palpation, client symptom irritability and examiner technique. Pulse monitoring is especially examiner-dependent and should be interpreted cautiously.

Validity is limited because the test does not isolate one thoracic outlet space or one anatomical structure. A positive result indicates symptom reproduction during costoclavicular-style loading, not proof of neurovascular compression.

Validity improves when the result is interpreted with a careful history, symptom behaviour, neurological examination, vascular screening, cervical assessment, shoulder assessment and other thoracic outlet provocation tests.

Common Errors and Limitations

Common errors include:

• Using pulse change alone as a positive result
• Pulling the shoulders too aggressively
• Holding the test too long
• Ignoring dizziness, colour change or coldness
• Failing to ask whether symptoms are familiar
• Using the test alone to diagnose TOS
• Not recording shoulder position or duration
• Ignoring cervical radiculopathy or peripheral nerve contributors
• Missing urgent vascular referral indicators

Limitations include false positives, variable protocols, uncertain reference standards for TOS, overlap with cervical and shoulder symptoms, and limited stand-alone diagnostic certainty.

Practical Applications

The Eden Test can be useful when documenting whether a costoclavicular-style posture reproduces upper-limb symptoms. It may guide whether further thoracic outlet testing, vascular screening, neurological screening, cervical assessment, shoulder assessment or referral is needed.

For education, the test reinforces the importance of symptom relevance. A pulse change without familiar symptoms should be interpreted carefully, while familiar symptom reproduction with vascular-type changes should be documented clearly and managed within professional scope.

How to Record This in Measurz

In Measurz, record:

• Test name: Eden Test or Costoclavicular Test
• Side tested or bilateral response
• Client position: sitting or standing
• Shoulder position: depressed, retracted or military brace
• Head and neck position
• Breathing instruction if used
• Result: positive, negative, unclear or unable to test
• Pain or symptom score before, during and after
• Symptom location
• Symptom quality
• Whether symptoms were familiar
• Pulse response if monitored
• Vascular symptoms: colour change, coldness, swelling or heaviness
• Neurological symptoms: numbness, tingling, weakness or paraesthesia
• Dizziness or feeling unwell
• Time held
• Comparison side
• Reason for stopping
• Confidence in result
• Related Adson’s, Halstead, Roos, Wright, cervical, shoulder, neurological and vascular findings
• Referral notes if vascular symptoms are concerning

Recording these details improves repeatability, assessment reasoning, team communication, client education and reporting quality.

Related Tests / Internal Links

• Adson’s Test
• Halstead Test
• Roos Stress Test
• Wright Test
• Cervical Rotation Lateral Flexion Test
• Cervical Distraction Test
• Spurling’s Test
• Upper Limb Tension Test
• Cervical ROM Assessment
• Shoulder ROM Assessment
• Grip Strength Test
• Neurological Screen

FAQs

What is the Eden Test used for?

The Eden Test is used to assess whether costoclavicular-style shoulder positioning reproduces familiar upper-limb neurological or vascular-type symptoms.

What is a positive Eden Test?

A positive finding is reproduction of familiar symptoms such as arm heaviness, tingling, numbness, coldness, colour change or vascular-type symptoms during the test position.

Does the Eden Test diagnose thoracic outlet syndrome?

No. It may support suspicion of thoracic outlet involvement, but it does not diagnose TOS on its own.

Is pulse change enough for a positive test?

Pulse change alone should be interpreted cautiously. Symptom reproduction and clinical context are more meaningful than pulse change by itself.

What is a negative Eden Test?

A negative result means the test did not reproduce familiar symptoms or a concerning vascular response. It does not fully exclude thoracic outlet involvement.

When should the test stop?

Stop for dizziness, colour change, coldness, worsening neurological symptoms, marked symptom escalation, pulse concern with symptoms or feeling unwell.

What should be recorded in Measurz?

Record shoulder position, symptoms, pulse response if used, vascular signs, neurological signs, time held, reason for stopping and related test findings.

Key Takeaways

The Eden Test is a thoracic outlet symptom provocation test.
It is commonly used to stress the costoclavicular space.
A positive result is most meaningful when familiar symptoms are reproduced.
Pulse change alone is not diagnostic.
Measurz should capture symptoms, pulse response, position, safety response and related findings.

References

Dessureault-Dober, I., Bronchti, G., & Bussières, A. (2018). Diagnostic accuracy of clinical tests for neurogenic and vascular thoracic outlet syndrome: A systematic review. Journal of Manipulative and Physiological Therapeutics, 41(9), 789–799. https://doi.org/10.1016/j.jmpt.2018.02.007

Gillard, J., Pérez-Cousin, M., Hachulla, É., Remy, J., Hurtevent, J. F., Vinckier, L., Thévenon, A., & Duquesnoy, B. (2001). Diagnosing thoracic outlet syndrome: Contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine, 68(5), 416–424.

Hooper, T. L., Denton, J., McGalliard, M. K., Brismée, J. M., & Sizer, P. S. (2010). Thoracic outlet syndrome: A controversial clinical condition. Part 1: Anatomy, and clinical examination/diagnosis. Journal of Manual & Manipulative Therapy, 18(2), 74–83. https://doi.org/10.1179/106698110X12640740712734

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. https://doi.org/10.3389/fcvm.2022.802183

Yildizgoren, M. T., & Ekiz, T. (2022). Diagnostic values of clinical diagnostic tests in thoracic outlet syndrome. Turkish Journal of Physical Medicine and Rehabilitation, 68(1), 54–60.