Roos Test for Thoracic outlet syndrome

The Roos Test (also known as the Elevated Arm Stress Test) is a provocative clinical assessment primarily used in physical therapy and orthopedics to evaluate for Thoracic Outlet Syndrome (TOS). Unlike the ROOS (Quick Assessment of Symptoms and Status) questionnaire, which focuses on symptom severity and functional impact, the physical Roos Test is designed to reproduce symptoms associated with vascular or neurological compression in the thoracic outlet.Clinical Guide: The Roos TestIndication

The Roos Test is indicated for patients presenting with symptoms suggestive of Thoracic Outlet Syndrome, such as:

• Pain in the neck, shoulder, or arm.
• Numbness, tingling, or paresthesia in the hand and fingers (often the ulnar distribution).
• Weakness or a feeling of "heaviness" in the affected limb.
• Symptoms aggravated by overhead activities.

Application & Patient Positions

The test is administered with the patient in either a seated or standing position:

1. Start Position: The patient abducts both arms to 90 degrees, externally rotates the shoulders, and flexes the elbows to 90 degrees (often described as the "surrender" or "stick-em-up" position).
2. Dynamic Action: The patient is instructed to open and close their hands slowly and consistently for a duration of three minutes.
3. Observation: The therapist monitors the patient's ability to maintain the position and report any reproduction of symptoms.

Positive Findings

A test is considered positive if the patient is unable to maintain the start position for the full three minutes, or if the following symptoms are reproduced:

• Significant pain or discomfort in the shoulder or arm.
• Severe heaviness or fatigue in the limb.
• Numbness or tingling (paresthesia) in the hand or fingers.
• Inability to continue opening/closing the hands due to cramping or weakness.

Negative Findings

A test is considered negative if the patient can maintain the position for the full three minutes without reporting significant neurological or vascular symptoms, or only experiencing mild, generalized muscle fatigue that does not mimic their chief complaint.

Conclusion

The Roos Test is a valuable screening tool in the physical therapy assessment of Thoracic Outlet Syndrome. While it is highly sensitive, it should be used in conjunction with other diagnostic measures (such as the Adson’s test or Tinel’s sign) and a thorough clinical history to confirm a diagnosis, as false positives can occur in patients with shoulder pathology or general fatigue.