The Roos Stress Test, also called the Elevated Arm Stress Test or EAST, assesses symptom response during sustained overhead arm positioning and repeated hand opening and closing. A positive finding may include familiar arm symptoms, fatigue, heaviness, paraesthesia or vascular-type symptoms. A 2022 study found that standardised EAST parameters had good test-retest reliability for duration and grip strength measures, but low discriminative value for diagnosing neurogenic thoracic outlet syndrome.
A client reports arm heaviness or tingling when working overhead, carrying load or maintaining elevated arm positions. Symptoms may take time to appear, and short provocation tests may not reproduce them. The Roos Stress Test can help document symptom response to sustained arm elevation.
However, a positive Roos Test does not diagnose thoracic outlet syndrome. Many clients can experience fatigue or discomfort in this position, so the result must be interpreted with symptom familiarity, timing, vascular and neurological findings, and broader assessment.
Test name: Roos Stress Test
Also known as: Elevated Arm Stress Test, EAST
Body region: Thoracic outlet, shoulder girdle, upper limb and neurovascular bundle
Purpose: Assess symptom response to sustained elevated arm loading
Positive finding: Reproduction of familiar upper-limb symptoms, fatigue, heaviness, paraesthesia or vascular-type symptoms
Negative finding: No familiar symptoms or concerning response during the test period
Best used with: History, vascular screen, neurological screen, Adson’s, Eden, Halstead, Wright, cervical assessment and shoulder assessment
Key limitation: Low stand-alone diagnostic value for neurogenic TOS
The Roos Stress Test places both arms in an elevated position, commonly with shoulders abducted and externally rotated and elbows flexed. The client repeatedly opens and closes the hands for a set time while symptoms are monitored.
The test challenges the thoracic outlet region, shoulder endurance, upper-limb circulation and neural sensitivity.
The test is used when symptoms appear during overhead or sustained arm positions.
It may help document:
Arm fatigue
Paraesthesia
Heaviness
Pain
Symptom timing
Side-to-side symptom difference
Vascular-type symptoms
Tolerance to elevated arm loading
The test assesses symptom response and endurance during an elevated arm position. It does not isolate the thoracic outlet, brachial plexus or vascular structures.
It may be influenced by shoulder endurance, neck position, grip fatigue, pain sensitivity, cardiovascular factors, anxiety and arm conditioning.
This test may be useful for clients with upper-limb symptoms during overhead work, throwing, swimming, hairdressing, trade work, gym training or prolonged arm elevation.
Use when sustained arm elevation is relevant to the client’s symptoms and the position can be performed safely.
Use caution with severe vascular symptoms, unexplained arm swelling, colour change, coldness, suspected clotting, cardiovascular symptoms, dizziness, severe neurological symptoms, acute shoulder pain or inability to hold the arm position.
Stop immediately if vascular or neurological symptoms escalate.
Chair or standing space
Timer
Pain and symptom scale
Measurz recording workflow
Optional grip fatigue notes
Optional vascular and neurological screen notes
Position the client sitting or standing.
Ask the client to abduct and externally rotate both shoulders with elbows flexed, according to the selected method.
Stand in front of the client to observe posture, arm position, hand movement and symptoms.
No manual contact is usually required unless safety support is needed.
Ask the client to maintain the arm position without excessive shoulder shrugging or trunk compensation.
Ask the client to repeatedly open and close the hands for the selected time or until symptoms require stopping.
Ask the client to report pain, heaviness, tingling, numbness, fatigue, colour change, coldness, weakness or familiar symptoms.
A positive test is reproduction of familiar symptoms, early symptom onset, marked fatigue or vascular-type symptoms.
A negative test is no familiar symptom reproduction or concerning response during the test.
Stop if symptoms increase sharply, vascular signs occur, dizziness appears, neurological symptoms worsen, arm position cannot be maintained or the client requests to stop.
Record symptom onset time and reason for stopping. Do not treat fatigue alone as diagnostic.
A positive Roos Stress Test may support thoracic outlet involvement when it reproduces familiar upper-limb symptoms in a relevant position. It does not diagnose TOS.
A negative test does not exclude TOS, especially if the client’s symptoms are activity-specific, intermittent or provoked by other arm positions.
Interpretation is stronger when paired with history, neurological and vascular screening, cervical assessment, shoulder assessment and other thoracic outlet provocation tests.
A 2022 study of the standardised elevated arm stress test found area under the receiver operating characteristic curve values from 0.59 to 0.77 when proven NTOS was compared with asymptomatic and symptomatic controls, and positive and negative predictive values ranging from 46% to 65% and 51% to 66%. The authors concluded that discriminative value was low for NTOS diagnosis.
These findings support using the Roos Stress Test as a symptom and outcome measure rather than a stand-alone diagnostic test.
The same 2022 study reported moderate-to-good test-retest reliability for duration and grip strength parameters but poor reliability for grip fatigue parameters. This suggests that standardised measures may be useful for tracking change, but diagnostic interpretation remains limited.
Common errors include treating fatigue alone as positive, failing to record symptom onset time, ignoring vascular signs, allowing inconsistent arm position, not recording the reason for stopping and diagnosing TOS from the test alone.
Limitations include shoulder endurance contribution, low discriminative value, symptom non-specificity, posture variation, test duration effects and client effort.
Use the Roos Stress Test to record tolerance to sustained elevated arm positioning, symptom onset time and reasons for stopping. It may be useful for tracking change over time when performed consistently.
Record test name, result, symptom onset time, total duration, side affected, pain score, symptom location, symptom quality, arm position, hand movement speed, fatigue level, vascular symptoms, neurological symptoms, dizziness, reason for stopping and confidence in result.
Add related cervical ROM, shoulder ROM, Adson’s, Eden, Halstead, Wright, grip strength and neurodynamic testing notes.
Adson’s Test
Eden Test
Halstead Test
Wright Test
Upper Limb Tension Test
Cervical ROM Tests
Shoulder ROM Tests
Grip Strength Test
It assesses symptom response and tolerance during sustained elevated arm positioning.
A positive finding is reproduction of familiar symptoms, early symptom onset or concerning vascular-type symptoms.
No. Recent evidence shows low discriminative value for neurogenic TOS diagnosis.
Fatigue should be recorded, but fatigue alone should not be treated as diagnostic.
Record symptom onset time, total duration, symptoms, side, arm position and reason for stopping.
The Roos Stress Test is an elevated arm symptom provocation test.
It may reproduce TOS-like symptoms but is not diagnostic alone.
Recent evidence shows low diagnostic discriminative value.
It may be useful for tracking symptom onset and tolerance.
Measurz should capture onset time, symptoms, duration and stopping reason.
Pesser, N., de Bruijn, B. I., Goeteyn, J., Verhofstad, N., Houterman, S., van Sambeek, M. R. H. M., Thompson, R. W., van Nuenen, B. F. L., & Teijink, J. A. W. (2022). Reliability and validity of the standardized elevated arm stress test in the diagnosis of neurogenic thoracic outlet syndrome. Journal of Vascular Surgery, 76(3), 821–829.e1.
Masocatto, N. O., Da-Matta, T., Prozzo, T. G., Couto, W. J., & Porfirio, G. (2022). Thoracic outlet syndrome: A narrative review. Frontiers in Cardiovascular Medicine, 9, 802183.
