Roos Stress Test

What is the Roos Stress Test?

The Roos Stress Test, also called the Elevated Arm Stress Test or East Test, is a physical examination used for diagnosing thoracic outlet syndrome (TOS). This test helps evaluate symptoms that occur when there is compression in the thoracic outlet, where the nerves and blood vessels pass between the collarbone and the first rib. During the test, the patient raises their arms, externally rotates them, flexes their elbows to 90 degrees, and repeatedly opens and closes their hands for about three minutes.

Thoracic outlet syndrome occurs when there is compression of the nerves or blood vessels in the space between the collarbone and the first rib (Lee et al., 2010). There are several types of TOS, including neurogenic thoracic outlet syndrome (caused by nerve compression), venous thoracic outlet syndrome (caused by compression of veins), and arterial TOS (caused by artery compression). This compression can cause symptoms such as pain in the neck, shoulder, and arms, as well as numbness, weakness, and swelling in the affected limb. Other conditions, such as complex regional pain syndrome, can have overlapping symptoms with TOS.

The Roos Stress Test is often performed when a patient presents with unexplained neck pain, numbness, or symptoms suggestive of brachial plexus or blood vessel compression. Due to its ability to recreate symptoms in patients with thoracic outlet compression syndrome, it serves as a valuable screening tool when combined with other provocative tests, enhancing diagnostic accuracy (Brantigan and Roos, 2004).

How to use our Roos Stress Test template

Our Roos Stress Test template provides detailed instructions for conducting the test, along with fields to record patient information and test results. Healthcare professionals can use it to document findings and evaluate potential thoracic outlet syndrome symptoms.

Step 1: Access the template

Click the "Use template" button to open and customize the template within the Carepatron app. You can modify it, share it, or print it as needed. Alternatively, use the "Download" button to get a non-customizable, fillable, and printable PDF version for immediate use.

Step 2: Assess the patient

Follow the test procedure outlined in the template, ensuring the patient is in the proper position and performs the hand movements for the required three minutes. Observe and record any symptoms such as pain, numbness, or difficulty maintaining the position.

Step 3: Document the results

Use the template fields to log whether the patient showed a positive or negative test result. Note any specific symptoms observed during the test and their intensity, as well as any patient feedback on discomfort or pain.

Step 4: Discuss the results

After the test, explain the findings to the patient. If the results suggest thoracic outlet syndrome or any other potential issue, recommend further testing or evaluation to confirm the diagnosis.

While the Roos Stress Test is a useful screening tool, it should be used alongside other evaluations for a comprehensive diagnosis (Brantigan and Roos, 2004).

How to conduct the Roos Stress Test

Conducting the Roos Stress Test requires minimal equipment and can be performed in a seated or standing position. The following steps outline the correct procedure for administering the test:

1. Have the patient sit or stand comfortably. Ask them to abduct their shoulders to 90 degrees and externally rotate their arms. Ensure their elbows are flexed to 90 degrees and positioned slightly behind the frontal plane of the chest.
2. Ask the patient to repeatedly open and close their hands for three minutes while maintaining the position. Let them know to report any symptoms such as pain, tingling, numbness, or heaviness.
3. Monitor the patient for signs of discomfort, discoloration of the hands, or inability to maintain the position. Ensure they keep the position and repeatedly open and close their hands for the full three minutes unless symptoms become too severe to continue.

The Roos Stress Test results are based on the presence or absence of specific symptoms during or after the three-minute exercise. A positive test occurs if the patient experiences any of the following symptoms:

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 the person completes this exercise and has only complained or shown signs of minimal discomfort or forearm muscle fatigue, then their results are negative, which means normal.

Do note that a positive Roos test is not an official diagnosis yet. 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. Differential diagnosis is critical as there are other disorders and problems that have several similar symptoms as TOS, such as disk derangement syndrome (Gillard et al., 2001).

Treatments for thoracic outlet syndrome

Treatment for thoracic outlet syndrome depends on the severity of the condition and the specific type (neurogenic, venous, or arterial). The goal of treatment is to alleviate symptoms and improve function, and it often begins with non-invasive methods.

• Physical therapy: The first line of treatment for most cases of TOS involves physical therapy. It focuses on strengthening the muscles around the shoulder, improving posture, and increasing range of motion. This can help alleviate compression on nerves and blood vessels.
• NSAIDs and pain management: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce inflammation and relieve pain. For more significant pain or inflammation, corticosteroid injections may be used to provide temporary relief.
• Lifestyle modifications: Patients may be advised to modify their activities, especially those that involve repetitive overhead arm movements, to reduce pressure on the thoracic outlet.
• Surgical treatment: In severe cases where conservative treatments fail, surgical options, such as decompression surgery, may be necessary to relieve nerve or blood vessel compression.

What are the benefits of the Roos Stress Test?

The Roos Stress Test offers several advantages for healthcare professionals and patients when diagnosing thoracic outlet syndrome. Its practical benefits make it a preferred option in various clinical settings for initial screening.

Quick and simple screening

The Roos Stress Test is an easy-to-administer diagnostic tool that can be performed in a short amount of time. Its straightforward procedure allows healthcare professionals to quickly assess patients for potential thoracic outlet compression syndrome without the need for complex equipment.

Non-invasive and low-risk

As a non-invasive diagnostic test, the Roos Stress Test poses minimal risk to patients. It does not involve any surgical interventions, making it a safe option to screen for thoracic outlet syndrome before recommending more advanced diagnostic tests or treatments. This makes it ideal for initial evaluations, as it allows for a basic yet effective assessment of the condition.

References

Brantigan, C. O., & Roos, D. B. (2004). Diagnosing thoracic outlet syndrome. Hand Clinics, 20(1), 27–36. https://doi.org/10.1016/s0749-0712(03)00080-5

Gillard, J., Pérez-Cousin, M., Hachulla, É., Remy, J., Hurtevent, J.-F., Vinckier, L., Thévenon, A., & Duquesnoy, B. (2001). Diagnosing thoracic outlet syndrome: Contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine, 68(5), 416–424. https://doi.org/10.1016/s1297-319x(01)00298-6

Lee, J., Laker, S., & Fredericson, M. (2010). Thoracic outlet syndrome. PM&R, 2(1), 64–70. https://doi.org/10.1016/j.pmrj.2009.12.001