Which provocative test involves placing the arm at 90 degrees of abduction with external rotation to provoke symptoms?

• A. Adson's test
• B. Allen maneuver
• C. Wright Hyperabduction test
• D. ROOS test

Answer: (C)

Provocation testing for thoracic outlet syndrome relies on placing the shoulder in positions that narrow the space where the nerves and blood vessels pass, so that any existing compression is reproduced. The Wright hyperabduction test specifically uses a hyperabducted arm position—often with the elbow extended and the arm brought overhead—to maximize compression under the coracoid process and through the space beneath the pectoralis minor. In this position, the neurovascular bundle is stressed as it passes in front of the chest wall, so symptoms such as numbness, tingling, or fatigue can be reproduced if there's compression in that area. This targeted approach makes the hyperabduction maneuver a useful way to identify pectoralis minor–related thoracic outlet compression, which is why it’s the test described here.