Roos Stress Test

If you have a patient complaining about numbness in arms, hands, and/or fingers, administer the Roos Stress Test to gauge if they possibly have Thoracic Outlet Syndrome (TOS)!

By Matt Olivares on Jul 15, 2024.

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Fact Checked by RJ Gumban.

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What is the Roos Stress Test?

Before we discuss the , let’s first discuss Thoracic Outlet Syndrome.

Thoracic Outlet Syndrome (or TOS, for short) is a condition resulting from the compression of nerves and blood vessels between the collarbone and the thoracic outlet. A person with this condition may suffer from shoulder and neck pain and numb arms, hands, and fingers.

Suppose a patient sets up an appointment with you to have themselves checked because they are feeling pain in their shoulders and/or neck, plus they feel that their arms, hands, and fingers are numb. One way to determine if they are possibly dealing with Thoracic Outlet Syndrome is to administer the Roos Stress Test.

The Roos Stress Test is a physical examination technique with the patient repeatedly opening and closing their hands for approximately three minutes. The reason for this is that this particular short exercise can reproduce the symptoms of Thoracic Outlet Syndrome. If the patient feels pain at any point during this exercise, the person may be dealing with TOS. If that’s the case, they will be recommended to take other assessments to confirm the diagnosis.

How to conduct the Roos Stress Test

Before you conduct the Roos Stress Test, you must make sure that there is a flat and comfortable seat in the space where you will be administering the test, plus, you must have a stopwatch to time the test.

Once you have both of these, please follow these instructions:

  • Have your patient take a seat and make sure they are sitting in an upright position.
  • Tell them to relax their shoulders and arms.
  • Have them raise their and externally rotate them by 90 degrees.
  • While their arms are raised and externally rotated by 90 degrees, have them flex their elbows by 90 degrees.
  • Tell them to maintain their pose.
  • While maintaining their pose, you will instruct them to flex and extend their fingers repeatedly, meaning they need to open and close their hands repeatedly. This will go on for three minutes. Tell them they will start as soon as you say “GO” and stop as soon as you say “STOP.” Also, tell them to talk to you about what they feel as they do this exercise.
  • After giving them the instructions, ready your stopwatch and activate it as soon as you say “GO.” Then, as soon as the stopwatch hits the three-minute mark, say “STOP” and pause your stopwatch.
  • Make sure to log what the patient felt while performing the exercise. We have a template for you that you can use. We will discuss this later on in this guide.

How to interpret Roos Stress Test results

The Roos Stress Test is a type of physical examination technique that is not scored. Instead, you will be taking note of certain symptoms.

If the person completes this exercise and has only complained or shown signs of minimal discomfort/distress as well as forearm muscle fatigue, then their condition can be designated as Normal.

Now, here are the possible symptoms of Thoracic Outlet Syndrome to look out for:

  • Increase in neck and shoulder pains
  • The increase in neck and shoulder pains also extends down their arms
  • Tingling or prickling feelings in their forearms and fingers
  • Paleness of arms
  • Reactive hyperemia when they lower their arms
  • Cyanosis in their hands
  • Swelling in their hands

If they have any of these symptoms, their condition can be designated as Positive. If they cannot complete the exercise and drop their arms while in pain or distress, that counts as Positive as well.

Do note that Positive designations are not official diagnoses. They are just there to state the high possibility that the patient is positive for Thoracic Outlet Syndrome. The next step is to endorse the patient for other evaluations and tests to make an official diagnosis.

There are other symptoms that are indicative of other problems that you can detect using this test:

  • If they only feel mild distress/discomfort in their arms or hands but they feel pain in their neck and shoulders, then they might have cervical disc syndrome.
  • If they feel intense pain in their shoulders and the pain is something they find to be unbearable, then they might have shoulder problems that need to be examined.
  • If there is compression in the nervous medianus and the patient complains about numbness in the first three fingers of either hand, they might have carpal tunnel syndrome.

As with TOS, just because they have these symptoms doesn’t mean they have the problems mentioned above, so you’ll have to endorse them for other examinations to confirm the suspicions.

When is it best to conduct the Roos Stress Test?

There are three appropriate times when the Roos Stress Test is normally administered.

The first would be when a patient sets up an appointment with you to talk about pains in their shoulder and/or neck or if there is numbness in their arms, hands, and/or fingers. During the appointment, it’s best to administer this test to gauge the patient and their pain, and then endorse them for further examination, if needed.

The second would be if a healthcare professional looks at a patient’s records and notices that, based on their medical history and symptoms, signs indicate the possibility that the patient is at risk of developing Thoracic Outlet Syndrome. If that’s the case, the Roos Stress Test should be administered.

Now, one of the points we mentioned earlier is that, after conducting the test, the next step is to endorse them for other tests to confirm if the patient has TOC. This is because the test on its own is not enough to get a complete picture of the patient’s problems.

Given this, the best time to conduct the Roos Stress Test is during a comprehensive examination, a series of different tests to fully analyze a patient and confirm all the possible physical conditions they are dealing with.

Who can conduct the Roos Stress Test?

Since the Roos Stress Test was specifically created to gauge symptoms of Thoracic Outlet Syndrome, the following healthcare professionals can conduct this test on their patients:

  • Physical Therapists
  • Occupational Therapists
  • Physiatrists
  • Orthopedists
  • Neurologists

It’s best to only conduct this test by the professionals mentioned above. If you’re wondering why these are the best professionals to conduct it, that’s because they are trained and experienced in properly evaluating patients for TOC and other similar conditions. They know the signs well and can determine how to manage and treat these problems.

The Roos Stress Test may be easy to conduct, and you don’t need any special equipment to conduct it, but that doesn’t mean anyone can just do so.

It’s also not a diagnostic test but rather part of a series of tests that must be done to confirm and make an official diagnosis. The results of this test are based on observations, and it isn’t scored, which is why experts in musculoskeletal examinations should conduct it. This is so that the information provided based on the Roos Stress Test is accurate and well-considered, and can be properly used when making official diagnoses.

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What are the benefits of the Roos Stress Test?

This is a quick test that can provide instant results.

The Roos Stress Test is an inexpensive test to conduct because it doesn’t require special equipment. You only need a flat and comfortable surface for your patient to sit on and a stopwatch.

The instructions are straightforward and easy to do. It should only take a few minutes to complete this test (approximately 4 to 5 minutes), which means you can get results immediately and pass the information to the next person handling the patient as part of a comprehensive examination.

It is a non-invasive and low-risk test.

Given that the person will be seated while following the instructions, this test will not put the patient at risk. Some physical examinations may have risks depending on the kind of activity that a patient must perform, but since this one doesn’t require them to do anything involving their entire body, it is a safe test to administer.

At most, the patient will feel discomfort in their shoulders, arms, hands, and/or fingers, given that they will keep their arms raised for three minutes. They can stop midway through the test if they feel unbearable pain. They will be designated a positive test result, though.

It can help professionals determine what goes into treatment.

If the Roos Stress Test results are confirmed by other tests and an official diagnosis has been made, the results can help healthcare professionals determine what goes into a patient’s treatment.

Is the patient’s condition so bad that surgery is the only treatment solution? Do they just need to follow a physical therapy or physical rehabilitation program to improve their condition? Do they require any medication, and if so, what are the dosages, and how often do they have to take each one?

These are just some of the questions that the test results can answer.

Is the Roos Stress Test a one-time, big-time test?
Is the Roos Stress Test a one-time, big-time test?

Commonly asked questions

Is the Roos Stress Test a one-time, big-time test?

Not necessarily. You can re-administer this test to a patient down the line as part of a routine checkup to see if they are getting better, especially if they have been following a treatment plan post-diagnosis.

Does the Roos Stress Test hurt?

That depends. Most of the time, no. More often than not, the patient taking this test will feel discomfort in their upper extremities, given that they have to elevate their arms, flex their elbows, as well as open and close their hands for three minutes. If there is pain, that’s because their upper extremities are in pain, to begin with. That’s also a sign that they might have TOS or another condition.

Is the Roos Stress Test reliable?

Yes, so long as the person conducting it is highly trained and experienced with conducting and interpreting musculoskeletal-related examinations. False negatives and false positives are possible, but that’s why it’s always recommended to include this as part of a more comprehensive examination in order to confirm if the results are accurate or not.

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