Roos Stress Test
Original Editors - Yves Hubar
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Purpose
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
Please refer to the Thoracic Outlet Syndrome (TOS) page.
Technique
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
Evidence
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.
Resources
The following videos both demonstrate how the Roos Stress Test is performed. In the first video, the patient can adopt either a standing or a sitting position with shoulder abduction, elbow in 90 degrees External Rotation. The patient is requested to slowly open then close hands for 3 minutes. The findings are positive if there is repetition of symptoms or if there is inability to maintain the starting position for 3 minutes.
Key Research
A study ( by Gillard et al. 2001) evalautaedthe usefulness of certain provocative tests ( Doppler Ultrasonography, electrophysiological investigations, helical computed tomography (CT) angiography in 48 patients with Thoracic Outlet Syndrome (TOS). While the Doppler ultrasonography confirmed the diagnosis with five or more positive provocative tests, the electrophysiological studies were found to be useful for differential diagnoses and detection of associated abnormalities. The efficacity of the CT angiography in the diagnosis of TOS was not clear [5].
References
- ↑ Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand clinics. 2004 Feb 1;20(1):27-36.
- ↑ Lee J, Laker S, Fredericson M. Thoracic outlet syndrome. PM&R. 2010 Jan;2(1):64-70.
- ↑ sptshoulderexamtests. Roos Test. Available from: http://www.youtube.com/watch?v=_dDWNQG1jB0 [last accessed 28/1/2025]
- ↑ Physical Therapy Nation. Roos Test for Thoraci Outlet. Available from: http://www.youtube.com/watch? v=4Jug2ByFRtM [last accessed 28/1/2025]
- ↑ 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 Oct 1;68(5):416-24.