Roos Stress Test

Original Editors - Yves Hubar

Top Contributors -

Purpose[edit | edit source]

This test is a diagnostic tool used in the identification of Thoracic Outlet Syndrome (TOS). It is also known as the “elevated arm stress test” or "EAST".

Clinically Relevant Anatomy[edit | edit source]

Please refer to the Thoracic Outlet Syndrome (TOS) page.

Technique[edit | edit source]

Starting postion: [1]

  • The patient has both arms in the 90° abduction-external rotation position
  • Shoulders and elbows are in the frontal plane of the chest


Execution:

  • The patient is to open and close the hands slowly over a 3-minute period


Results if normal:

  • Only forearm muscle fatigue and minimal distress


Possible symptoms if TOS is present:

  • gradual increase in pain at neck and shoulder, progressing down the arm
  • Paraesthesia in forearm and fingers
  • In case of arterial compression: arm pallor with arm elevated, reactive hyperemia when limb is lowered
  • In case of venous compression: Cyanosis and swelling
  • Inability to complete test, and patient drops arms in lap in marked distress, recognized as reproduction of usual symptoms
  • Reproduction of the usual symptoms that involve the entire extremity!


Possible results if carpal tunnel syndrome is present:

  • Numbness in first three fingers due to compression of nervus medianus


Possible results in case of cervical disc syndrome:

  • Pain in neck and shoulder from holding arms elevated but minimal distress in arm or hand.


Possible results in case of orthopedic shoulder problems:

  • Intolerable symptoms confined to shoulder area


Diagnostic accuracy:[2]

  • Sensitivity: 84%
  • Specificity: 30%
  • PPV: 68%
  • NPV: 50%


Reliability:

  • Inter and intra-examiner reliability have not yet been found in the literature.


Key Research[edit | edit source]

Gillard J, Pérez-Cousin M, Hachulla É, Remy J, Hurtevent JF, Vinckier L, Thévenon A, Duquesnoy B. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine, 2001; 68(5): 416-424.

References[edit | edit source]

  1. Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand Clin. 2004 Feb;20(1):27-36. (evidence level E)
  2. 2: Lee J, Laker S, Fredericson M. Thoracic outlet syndrome. PM R. 2010 Jan;2(1):64-70. (Grade of evidence E)