Costoclavicular Brace Test

Retracting and depressing the shoulders, with the chest held forward, reduces the space between the clavicle and first rib. This position can place stress on the brachial plexus or subclavian vessels, making compression-related symptoms more apparent. Reproduced pain, paresthesia, weakness, or vascular change reflects the response to that position, not necessarily a confirmed structural lesion.

A reduced radial pulse may indicate that the maneuver affects subclavian or downstream vascular flow, but that finding is not specific by itself. Vascular changes can also occur in people without symptoms. Consequently, pulse reduction should be considered alongside the patient’s reported symptoms and other clinical findings rather than treated as definitive evidence of thoracic outlet syndrome.

Pain, paresthesia, and weakness suggest that the maneuver may be stressing neural structures associated with the brachial plexus, whereas a pulse change points toward a possible vascular response. These categories are not diagnostic on their own, and symptoms may overlap. Their main value is helping clinicians decide whether further neurologic, vascular, or imaging assessment is warranted.

The patient is positioned by retracting and depressing the shoulders, commonly while holding the chest forward. The examiner then assesses whether this position reproduces pain, paresthesia, or weakness and may observe for a reduced radial pulse. The maneuver should be interpreted as a bedside assessment of provoked findings, with the response documented for correlation with the broader examination.

Clinicians may include the maneuver when symptoms raise concern for thoracic outlet syndrome or possible compression of neurovascular structures near the costoclavicular region. A positive response can support the decision to pursue additional vascular, neurologic, or imaging evaluation. It is most useful as one component of the assessment rather than as an isolated basis for diagnosis.

A positive response should prompt careful review of which finding was reproduced, such as pain, paresthesia, weakness, or pulse reduction, and whether it matches the clinical presentation. Because the maneuver can produce vascular changes in asymptomatic individuals, the result requires cautious interpretation. Further evaluation may then focus on vascular studies, neurologic assessment, or imaging as clinically appropriate.