Wright’s Hyperabduction Test

Wright’s Hyperabduction Test (also known as the Hyperabduction Maneuver or Wright’s Test) is an orthopedic special test used to assess for thoracic outlet syndrome (TOS), specifically looking for neurovascular compression as the brachial plexus and axillary artery pass beneath the pectoralis minor and into the axilla.

Wright’s Hyperabduction Test

How the Test is Performed

  • Client is seated or standing with arms at their sides.

  • The therapist palpates the radial pulse on the side being tested and maintains palpation throughout the test.

  • Step 1: With the elbow flexed to 90° and shoulder in 90° abduction and external rotation, the therapist holds this position for up to 1 minute.

    • Observe for decrease, loss, or change in strength of the radial pulse and/or reproduction of neurological symptoms (numbness, tingling, weakness, pain).

  • Step 2: The therapist passively elevates the client’s arm further into full abduction (hyperabduction), holding for another minute while maintaining external rotation and monitoring the radial pulse.

  • A positive sign is either (1) an obvious decrease or disappearance of the radial pulse or (2) reproduction or worsening of upper extremity neurological symptoms during either phase.

Clinical Significance

  • A positive sign in the first position implicates compression at the level of the pectoralis minor (“retropectoralis minor space”); a positive result at maximum abduction suggests a more proximal or costoclavicular site of compression.

  • Clinical value is highest when the test reproduces the client’s familiar symptoms (numbness, tingling, heaviness, pallor, or weakness in the arm/hand).

Assessment

  • Use this test in clients with upper extremity numbness, tingling, pain, or vascular symptoms, especially if aggravated by elevation, abduction, or overhead activity.

  • Always compare both sides and document findings to monitor changes with treatment.

Treatment

  • If cleared for massage, focus on gentle soft tissue release for hypertonic pectoralis minor, subclavius, scalenes, and upper thoracic muscles to relieve pressure and restore mobility.

  • Postural and ergonomic re-education can help reduce contributing factors, such as rounded shoulders or prolonged overhead positions.

  • Avoid positions or techniques that further abduct or compress the shoulder if symptoms are easily reproduced.

Safety and Referral

  • Do not perform deep tissue or aggressive massage over the pectoralis minor/supraclavicular space in clients with positive Wright’s Test or diagnosed TOS, as this may worsen compression or provoke symptoms.

  • These areas are “endangerment sites” due to the location of the neurovascular bundle.

  • Refer clients for further medical assessment if the test is positive, especially if accompanied by severe or acute vascular/neurological symptoms.