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: 
- The patient has both arms in the 90° abduction-external rotation position
- Shoulders and elbows are in the frontal plane of the chest
- 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
- Sensitivity: 84%
- Specificity: 30%
- PPV: 68%
- NPV: 50%
- 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]
- Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand Clin. 2004 Feb;20(1):27-36. (evidence level E)
- 2: Lee J, Laker S, Fredericson M. Thoracic outlet syndrome. PM R. 2010 Jan;2(1):64-70. (Grade of evidence E)