Neck Orthopaedic Test: Costoclavicular/Military Brace or Eden’s Test

Costoclavicular or Military brace or Eden's test is a clinical maneuver used to evaluate for thoracic outlet syndrome (TOS). It is named after Dr. Wilfred Harris Costoclavicular, who first described the maneuver in 1937.

How to perform the Costoclavicular or Military brace or Eden's test:

1. Ask the patient to stand at attention with their shoulders held back and down, their head held straight, and their arms extended with the hands resting on the hips.
2. Palpate the radial pulse on both sides to establish a baseline.
3. While maintaining the same position, instruct the patient to take a deep breath and hold it.
4. Palpate the radial pulse on both sides again while the patient is holding their breath.
5. Compare the strength and presence of the radial pulses on both sides.
6. A positive test is indicated by a significant reduction or absence of the radial pulse on one side compared to the other.
7. Release the patient from the position and recheck the radial pulses to establish the baseline again.

The test is considered positive if there is a significant reduction or absence of the radial pulse on one side compared to the other, which suggests compression or obstruction of the blood vessels or nerves in the thoracic outlet. This may be due to narrowing of the thoracic outlet caused by an abnormality in the bony or soft tissue structures, such as a cervical rib, muscle hypertrophy, or a tight scalene muscle.

References:

1. Costoclavicular maneuver. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/007431.htm. 
2. Costoclavicular syndrome. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK538488/.
3. Eden R, Breck L. An evaluation of tests used to diagnose thoracic outlet syndrome. Arch Surg. 1949 Jan;58(1):85-91. doi: 10.1001/archsurg.1949.01240040090010. PMID: 18113690.
4. Costoclavicular syndrome. https://www.uptodate.com/contents/costoclavicular-syndrome.