The Roos Stress Test, also known as the Elevated Arm Stress Test or EAST, is a thoracic outlet provocation test where the client holds the arms elevated and repeatedly opens and closes the hands for up to three minutes. A positive test may include reproduction of familiar upper-limb symptoms, paraesthesia, heaviness, fatigue, weakness, vascular-type symptoms or inability to maintain the position. The test is sensitive to upper-limb loading and endurance demands but has limited stand-alone diagnostic value for thoracic outlet syndrome. It should be interpreted with history, vascular screening, neurological screening, cervical assessment, shoulder assessment and other thoracic outlet tests.
The Roos Stress Test is one of the most commonly used clinical tests in thoracic outlet assessment. It is designed to provoke symptoms by placing the upper limbs in an elevated position while the client repeatedly opens and closes the hands. This combination can stress the shoulder girdle, brachial plexus, vascular structures and upper-limb endurance capacity.
Because the test is physically demanding, symptom interpretation must be careful. Fatigue, burning, heaviness or discomfort can occur in people without thoracic outlet syndrome, especially if the test is held for the full three minutes. A meaningful positive finding is more likely when the test reproduces the client’s familiar symptoms, especially neurological or vascular-type symptoms that match the history.
The Roos Stress Test should not be used alone to diagnose thoracic outlet syndrome. It is best used as one part of a broader assessment that includes symptom history, vascular screening, neurological screening, cervical and shoulder assessment, and other thoracic outlet provocation tests.
Test name: Roos Stress Test
Also known as: Roos Test, Elevated Arm Stress Test, EAST
Body region: Thoracic outlet, shoulder girdle, cervical region and upper limb
Purpose: Assess symptom response to sustained elevated-arm positioning and repetitive hand movement
Commonly associated with: Thoracic outlet syndrome assessment and upper-limb neurovascular symptom screening
Positive finding: Reproduction of familiar symptoms, vascular-type symptoms or inability to maintain the test position
Negative finding: Able to complete the test without familiar symptoms or concerning vascular/neurological response
Best used with: Adson’s Test, Eden Test, Halstead Test, Wright Test, cervical assessment, shoulder assessment, neurological screen and vascular screen
Key limitation: The Roos Stress Test has limited stand-alone diagnostic value for TOS.
The Roos Stress Test is an elevated-arm provocation test. The client positions both shoulders in abduction and external rotation with the elbows flexed to approximately 90 degrees. The client then repeatedly opens and closes the hands, usually for up to three minutes, while symptoms are monitored.
The test may provoke symptoms by combining shoulder elevation, external rotation, sustained muscular activity, vascular demand and repetitive hand movement. Because it is an endurance-style provocation test, symptoms may reflect neurovascular sensitivity, muscular fatigue, shoulder endurance limitation, postural sensitivity or general upper-limb load intolerance.
The Roos Stress Test is used when thoracic outlet involvement is being considered as part of a broader upper-limb assessment. It may be relevant when a client reports symptoms during overhead work, sustained arm elevation, carrying, driving, grooming, throwing, swimming or upper-limb endurance tasks.
The test may help determine whether elevated-arm positioning reproduces familiar symptoms. It can also help document symptom onset time, symptom location, fatigue behaviour and whether symptoms resolve after lowering the arms.
The Roos Stress Test assesses:
Symptom response to sustained elevated-arm positioning
Upper-limb paraesthesia, heaviness or fatigue response
Possible neurovascular symptom behaviour
Vascular-type symptoms such as coldness, colour change or swelling
Shoulder girdle endurance and postural tolerance
Time to symptom onset
Ability to maintain the test position
Symptom recovery after lowering the arms
It does not directly diagnose neurogenic, venous or arterial thoracic outlet syndrome.
The test may be useful for clients with upper-limb symptoms that are provoked by overhead activity, sustained arm elevation, carrying, repetitive hand tasks or prolonged shoulder postures.
It may also be useful in education settings where professionals are learning to record symptom onset, endurance limitation and neurovascular symptom behaviour. It should be modified or avoided when symptoms are severe, vascular signs are prominent, or the client cannot safely maintain the position.
Use the Roos Stress Test when:
Thoracic outlet involvement is part of the assessment reasoning
Symptoms are provoked by elevated arm positions
The client can safely raise both arms
You can monitor symptom onset and safety signs
You can stop the test early if symptoms become concerning
The result will be interpreted with history and other tests
Use caution or avoid the test when there is unexplained arm swelling, colour change, marked temperature change, suspected vascular compromise, suspected clotting, faintness, dizziness, severe neurological deficit, acute trauma, severe shoulder pain, recent shoulder surgery, cervical instability concern, known vascular disease or symptoms requiring urgent medical review.
Stop immediately if dizziness, faintness, marked colour change, coldness, severe paraesthesia, worsening neurological symptoms, significant weakness, concerning vascular symptoms or client distress occurs.
The Roos Stress Test requires minimal equipment:
Chair or safe standing space
Timer or stopwatch
Pain and symptom rating scale
Symptom-location recording method
Measurz app for structured documentation
Optional video for posture and arm position review
Optional pulse or vascular observation if appropriate
Optional MAT notes for cervical, shoulder and neurovascular findings
Within Measurz, the Roos Stress Test can be recorded alongside Adson’s Test, Eden Test, Halstead Test, Wright Test, cervical ROM, shoulder ROM, grip strength, neurological screening and upper-limb neurodynamic tests. Measurz tools such as stopwatch, video recording, structured symptom notes and test comparisons can improve repeatability and tracking over time.
Explain that the test places the arms in an elevated position while the hands repeatedly open and close. Tell the client that the test can be stopped at any time and that the goal is to monitor symptoms, not to push through severe discomfort.
Record baseline symptoms before testing, including pain score, symptom location, hand temperature or colour concerns and any current neurological or vascular-type symptoms.
The client sits or stands upright. Sitting is often preferred for safety and consistency.
The client abducts both shoulders to approximately 90 degrees, externally rotates the shoulders, and flexes the elbows to approximately 90 degrees. The hands are held open at the start.
Stand in front of or beside the client to monitor posture, arm position, facial expression, hand colour, symptom behaviour and safety.
The client repeatedly opens and closes the hands at a steady pace for up to three minutes, unless symptoms or fatigue require earlier stopping.
Ask:
“Hold your arms in this position and slowly open and close your hands.”
“Tell me immediately if you feel tingling, numbness, heaviness, coldness, colour change, weakness or familiar symptoms.”
“We can stop at any time if symptoms become too strong.”
“Tell me if this reproduces the symptoms you usually experience.”
A positive finding may include reproduction of familiar upper-limb symptoms, paraesthesia, numbness, heaviness, vascular-type symptoms, marked weakness, inability to maintain position, or early symptom reproduction that matches the client’s history.
A negative finding is completion of the test without familiar symptoms, concerning vascular or neurological response, or meaningful inability to maintain the position.
Stop if symptoms become severe, dizziness occurs, marked colour change appears, the hand becomes cold, paraesthesia increases significantly, neurological symptoms worsen, the client cannot maintain the position safely, or the client asks to stop.
Do not force the client to complete three minutes if symptoms are significant. Time to symptom onset and reason for stopping are often more useful than completion alone.
A positive Roos Stress Test may increase suspicion that elevated-arm loading is relevant when it reproduces the client’s familiar symptoms. It is more meaningful when symptoms match the client’s history, occur early, include neurological or vascular-type features, and are supported by other thoracic outlet findings.
A positive result does not confirm thoracic outlet syndrome or identify whether symptoms are neurogenic, venous or arterial. Symptoms may also be influenced by shoulder endurance, muscular fatigue, cervical radicular symptoms, peripheral nerve sensitivity, vascular sensitivity, postural intolerance or general deconditioning.
A negative Roos Stress Test means the test did not reproduce familiar symptoms or concerning vascular/neurological signs during the tested period. This does not exclude thoracic outlet involvement, especially if symptoms occur only in specific occupational, sport or load-related contexts.
The Roos Stress Test has been widely used, but diagnostic accuracy evidence is mixed and should be interpreted cautiously. It is often considered sensitive to symptom provocation but limited in specificity because many people can experience fatigue or discomfort in the elevated-arm position.
Systematic review evidence has highlighted that clinical tests for thoracic outlet syndrome have heterogeneous methods, variable reference standards and limited certainty. This makes it difficult to assign universally reliable sensitivity, specificity or likelihood ratio values for the Roos Stress Test across all TOS presentations.
Research using exercise oximetry during the Roos Test suggests that objective vascular or microvascular measurement may improve standardisation in research settings, but this is not the same as saying the standard clinical Roos Test alone can confirm TOS.
Overall, the Roos Stress Test should be interpreted as a symptom provocation and tolerance test. It may support assessment reasoning when familiar symptoms are reproduced, but it should not be used as a stand-alone diagnostic test.
Reliability depends on consistent arm position, hand-opening pace, test duration, symptom criteria and stopping rules. Small differences in shoulder elevation, elbow angle, hand movement speed and posture can change the difficulty of the test.
Validity is limited because the test is not specific to thoracic outlet syndrome. It loads the shoulder girdle, upper-limb muscles, nervous system and vascular system at the same time. A positive result reflects symptom reproduction during elevated-arm stress, not proof of neurovascular compression.
To improve consistency, professionals should record time to symptom onset, time to stopping, symptom quality, symptom location, posture, arm position and whether symptoms were familiar.
Common errors include:
Treating fatigue alone as diagnostic
Forcing the client to complete three minutes despite strong symptoms
Not recording time to symptom onset
Not recording reason for stopping
Ignoring vascular signs such as colour change or coldness
Failing to ask whether symptoms are familiar
Using the test alone to diagnose TOS
Allowing inconsistent arm position
Ignoring cervical, shoulder or peripheral nerve contributors
Not documenting symptom recovery after the test
Limitations include low specificity, high physical demand, variable protocols, overlap with shoulder endurance symptoms, and difficulty separating neurogenic, vascular and muscular contributors.
The Roos Stress Test can be useful for documenting how elevated-arm activity affects symptoms. It may be especially relevant when a client reports symptoms during overhead work, sustained arm tasks, sport, carrying or repetitive hand activity.
For Measurz and MAT education, the test is valuable because it encourages objective recording: time to symptom onset, time to stopping, symptom location, symptom quality and recovery after the test. These details are more useful than simply recording “positive” or “negative”.
In Measurz, record:
Test name: Roos Stress Test or Elevated Arm Stress Test
Client position: sitting or standing
Arm position
Test duration planned
Time to symptom onset
Time stopped
Reason for stopping
Pain or symptom score before, during and after
Symptom location
Symptom quality
Whether symptoms were familiar
Paraesthesia, numbness, heaviness or weakness
Vascular symptoms: colour change, coldness, swelling or heaviness
Hand fatigue or grip fatigue
Ability to maintain position
Recovery time after lowering arms
Result: positive, negative, unclear or unable to test
Confidence in result
Related Adson’s, Eden, Halstead, Wright, cervical, shoulder, neurological and vascular findings
Referral notes if vascular symptoms are concerning
Recording these details improves repeatability, assessment reasoning, team communication, client education, monitoring over time and reporting quality.
Adson’s Test
Eden Test
Halstead Test
Wright Test
Cervical Rotation Lateral Flexion Test
Cervical Distraction Test
Spurling’s Test
Upper Limb Tension Test
Cervical ROM Assessment
Shoulder ROM Assessment
Grip Strength Test
Neurological Screen
The Roos Stress Test is used to assess whether sustained elevated-arm positioning and repetitive hand movement reproduce familiar upper-limb symptoms.
A positive finding may include reproduction of familiar symptoms, paraesthesia, heaviness, vascular-type symptoms, significant weakness or inability to maintain the test position.
No. It may support suspicion of thoracic outlet involvement, but it does not diagnose TOS on its own.
Fatigue alone should be interpreted cautiously. The result is more meaningful when familiar neurological or vascular-type symptoms are reproduced.
Many protocols use up to three minutes, but the test should be stopped earlier if symptoms become significant or safety concerns occur.
A negative result means the client completes the test without familiar symptoms or concerning vascular or neurological response.
Record arm position, time to symptom onset, time stopped, symptoms, vascular signs, neurological signs, recovery time and related findings.
The Roos Stress Test is an elevated-arm symptom provocation test.
A positive result is most meaningful when familiar symptoms are reproduced.
Fatigue alone is not enough to confirm thoracic outlet involvement.
The test has limited stand-alone diagnostic value and should be interpreted with related findings.
Measurz should capture timing, symptoms, safety findings, recovery and related tests.
Dessureault-Dober, I., Bronchti, G., & Bussières, A. (2018). Diagnostic accuracy of clinical tests for neurogenic and vascular thoracic outlet syndrome: A systematic review. Journal of Manipulative and Physiological Therapeutics, 41(9), 789–799. https://doi.org/10.1016/j.jmpt.2018.02.007
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.
Henni, S., Hersant, J., Ammi, M., Mortaki, F.-E., Picquet, J., Feuilloy, M., & Abraham, P. (2019). Microvascular response to the Roos Test has excellent feasibility and good reliability in patients with suspected thoracic outlet syndrome. Frontiers in Physiology, 10, 136. https://doi.org/10.3389/fphys.2019.00136
Hooper, T. L., Denton, J., McGalliard, M. K., Brismée, J. M., & Sizer, P. S. (2010). Thoracic outlet syndrome: A controversial clinical condition. Part 1: Anatomy, and clinical examination/diagnosis. Journal of Manual & Manipulative Therapy, 18(2), 74–83. https://doi.org/10.1179/106698110X12640740712734
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. https://doi.org/10.3389/fcvm.2022.802183
Teijink, J. A. W., van Vollenhoven, B., van der Woude, L., et al. (2022). Reliability and validity of the standardised Elevated Arm Stress Test in the diagnosis of neurogenic thoracic outlet syndrome. Journal of Vascular Surgery, 76(3), 821–829.e1.
