Eden’s Test

Eden’s Test (Costoclavicular Test or Military Brace Test) is an orthopedic clinical assessment used to evaluate for thoracic outlet syndrome (TOS), specifically by detecting compression of the neurovascular structures (brachial plexus and/or subclavian artery) as they pass through the costoclavicular space between the clavicle and first rib.

How the Test is Performed

• Client position: Standing “at attention” (military posture) with shoulders drawn back and down, head forward, and chest out.

• The therapist palpates the radial pulse bilaterally to establish a baseline.

• The client is instructed to maintain this posture and may be asked to take a deep breath and hold, further drawing the shoulders down and back.

• Positive test: There is a significant reduction or disappearance of the radial pulse on one or both sides, and/or reproducible symptoms (numbness, tingling, pain in the arm or hand).

• The therapist should compare pulses before and after, and monitor for symptom reproduction.

Clinical Significance

• A positive Eden’s Test suggests compression of the neurovascular bundle in the costoclavicular space, often due to posture, muscular tightness (scalenes, subclavius), clavicular depression, or anatomical variations (cervical rib, hypertrophy).

• The test is one of several used to assess thoracic outlet syndrome. Others include Adson’s, Wright’s/Hyperabduction, and Roos’ tests.

• The test isolates compression associated with postural abnormalities or space narrowing in the costoclavicular interval.

Assessment

• Use this test for clients with:

  • Shoulder, neck, or upper extremity pain

  • Paresthesias (tingling), numbness, circulation changes in the arm/hand

  • Symptoms exacerbated by poor posture or overhead/lifting activities

• Document change in pulse strength, reproduction of symptoms, and which side(s) are affected.

Treatment

• If positive:

  • Avoid deep, compressive work over the costoclavicular space, first rib, or anterior chest wall in clients with suspected TOS.

  • Focus on postural correction, gentle soft tissue techniques for the scalenes, subclavius, pec minor, and upper thoracic muscles.

  • Integrate education and ergonomic advice for optimal upper body posture. Discourage excessive shoulder depression and retraction in at-risk clients.

  • Facilitate gradual stretching and mobility for tight anterior shoulder/neck muscles while promoting healthy scapular mechanics.

Safety and Referral

• If symptoms are severe, persistent, or progressive (especially if associated with weakness or vascular compromise), refer promptly to a physician, physiotherapist, or vascular specialist.

• Collaborate with the healthcare team for comprehensive TOS management including medical, rehabilitative, and postural interventions.