Neck Orthopaedic Test: Roos Stress Test

The Roos Stress Test, also known as the Elevated Arm Stress Test or the East Test, is a diagnostic test used in the identification of Thoracic Outlet Syndrome (TOS). It is designed to evaluate the compression or irritation of the brachial plexus (a network of nerves that originate in the neck and shoulder and control the movements and sensations in the arm) and/or subclavian artery (the main artery that supplies blood to the arm) as they pass through the thoracic outlet (the space between the collarbone and the first rib).

Procedure when performing the Roos Stress Test:

1. Explain the procedure to the patient and obtain their consent for the test.
2. Have the patient sit or stand in a comfortable position with their back straight and arms relaxed by their sides.
3. Instruct the patient to elevate both arms to 90 degrees, keeping their elbows straight and palms facing forward.
4. Instruct the patient to bend their elbows to 90 degrees, keeping their forearms parallel to the floor.
5. Instruct the patient to open and close their hands for 3 minutes while maintaining the arm position.
6. Observe the patient for any symptoms such as pain, numbness, tingling, or weakness in the hands or arms.
7. If the patient experiences any symptoms, stop the test immediately.
8. Record the results of the test in the patient's medical chart.

A normal result of the Roos Stress Test would be the absence of any symptoms such as pain, numbness, tingling, or weakness in the hands or arms during the 3-minute test period. 

References:

1. Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome: a review. Neurologist. 2008 Jan;14(1):365-73. doi: 10.1097/NRL.0b013e3181641b31. PMID: 18195648.
2. Kuhn JE, Lebus V, Bible JE, Emerson JW, Garretson R. Sensitivity and specificity of shoulder provocative tests for pathologies of the shoulder: a systematic review. J Athl Train. 2017;52(10):946-954. doi: 10.4085/1062-6050-52.9.02. PMID: 28937822; PMCID: PMC5621986.
3. Roos DB. Thoracic outlet syndrome is overdiagnosed. Surgery. 1988 Dec;104(6):931-6. PMID: 3053081.
4. Machleder HI. Evaluation of thoracic outlet compression syndrome with pulse-volume recordings and duplex scanning. J Vasc Surg. 1992 Oct;16(4):599-605; discussion 605-7. doi: 10.1016/0741-5214(92)90014-d. PMID: 1402176.