Wright’s Test (Hyperabduction Test)
- Fysiobasen
- Sep 13
- 3 min read
Wright’s test, also known as the hyperabduction test, is a provocation test used when thoracic outlet syndrome (TOS) is suspected. The test aims to identify compression in the axillary interval – the space behind the pectoralis minor muscle, where neurovascular structures pass from the thorax to the upper limb¹. It is particularly designed to detect vascular compromise and/or neurological symptoms during shoulder hyperabduction.
Execution
Purpose of the test
To evaluate possible compression of the subclavian artery and/or brachial plexus in the axillary region, as seen in vascular or neurogenic TOS¹.
How to perform the test:
Step 1 – 90° abduction:
The patient sits upright with the head in neutral position, eyes facing forward.
The examiner positions the arm in 90° abduction with slight external rotation.
The elbow is flexed to a maximum of 45°.
The arm is held passively in this position for one minute.
The examiner palpates the radial pulse throughout and monitors symptoms such as paresthesia, heaviness, numbness, or pain.
Step 2 – Hyperabduction:
The arm is brought further into end-range abduction (hyperabduction), still in slight external rotation and elbow flexion.
The test is repeated in the same way: radial pulse is assessed continuously, and symptoms are carefully noted.
Interpretation
Positive test:
A reduction or absence of the radial pulse and/or reproduction of the patient’s symptoms (tingling, numbness, pain, heaviness) constitutes a positive finding¹.
Findings during hyperabduction:
If symptoms worsen or the radial pulse weakens further in step 2, this supports axillary compression behind the pectoralis minor, as in pectoralis minor syndrome or structural narrowing of the thoracic outlet².
Structures Tested
Subclavian artery and brachial plexus:The passage through the axillary interval is narrowed during hyperabduction. Test positivity suggests compression in the area between ribs, pectoralis minor, and the coracoid process¹.
Tissues involved:Blood vessels and nerves are functionally stressed via provocation of symptoms and pulse changes, not structurally examined.
Common Errors
Incorrect elbow angle (more than 45° flexion can cause false findings).
Failure to assess the radial pulse before and during the test.
Head tilted to the side, which can influence the plexus and confound the result.
Insufficient abduction during step 2.
Inadequate symptom monitoring².
Evidence and Limitations
There is no single test that can reliably confirm or rule out thoracic outlet syndrome – especially not symptomatic TOS (sTOS)³.
Classic provocation tests, including Wright’s test, have shown low specificity and high false-positive rates – up to 90% pulse reduction has been reported in healthy individuals⁴.
Studies show high variability:
Hachulla (1990): high rate of false positives in asymptomatic subjects⁴.
Rayan & Jensen (1995): pulse reduction alone offers poor clinical prediction⁴.
Nannapaneni (2003): recommends combining with other tests to increase diagnostic value⁴.
Combination with Other Tests
Wright’s test has greatest clinical value when used as part of a test battery with:
Adson’s test
Eden’s (costoclavicular) test
Roos test (Elevated Arm Stress Test)
Direct nerve pressure or Tinel’s over the plexus
Combining tests increases sensitivity and reduces false positives. Nannapaneni and Rayan showed specificity rises significantly when two or more tests are positive simultaneously⁴.
Clinical Use and Criticism
Wright’s test is highly sensitive to vascular symptoms but has poor specificity when used in isolation. Pulse reduction without accompanying symptoms should be interpreted cautiously. The test is valuable as a provocation maneuver in combination with clinical history and examination but should not be used alone to diagnose TOS.
Kilder:
Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome part 1: clinical manifestations, differentiation and treatment pathways. Manual Therapy. 2009 1. des;14(6):586–595.
Magee DJ. Orthopedic Physical Assessment. Philadelphia: Elsevier Health Sciences; 2008.
