Roos Test (Elevated Arm Test): How to Check for TOS

The Roos Test, also known as the Elevated Arm Stress Test (EAST), is a highly effective special test for Thoracic Outlet Syndrome (TOS). It is designed to provoke symptoms by stressing the entire neurovascular bundle. Click the sections below for details.

1. Purpose

The primary purpose of the Roos Test (also known as the Elevated Arm Stress Test or EAST) is to **test for** Thoracic Outlet Syndrome (TOS). It is considered a highly sensitive test as it stresses the neurovascular bundle (brachial plexus and subclavian vessels) in all three potential compression sites: the interscalene triangle, the costoclavicular space, and the retropectoralis minor space.

2. How to Perform

1. The patient is positioned in sitting or standing.
2. The patient abducts both shoulders to 90 degrees and externally rotates them.
3. The patient flexes their elbows to 90 degrees. This is often called the "goal post" or "surrender" position.
4. The examiner instructs the patient to "Slowly open and close your hands (make fists)" repeatedly for up to 3 minutes.

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test (indicating compression) is one or more of the following:

• Reproduction of the patient's familiar symptoms (e.g., pain, numbness, tingling, or heaviness) in the arm, shoulder, or hand.
• The patient is auto to maintain the elevated position for the full 3 minutes.
• Visible signs of vascular compression, such as one hand becoming significantly paler or more cyanotic (blue) than the other.

Negative Sign (Test is NEGATIVE):
A negative test is when the patient can complete the 3-minute test without symptom reproduction. Minor fatigue in the forearm is not considered a positive sign.