Which test involves the patient holding the arms abducted and externally rotated with repeated hand openings to provoke symptoms in thoracic outlet syndrome?

• A. Adson's test
• B. Wright's test
• C. EAST (Elevated Arm Stress Test)
• D. Roos test

Answer: (D)

The key idea is dynamic compression of the thoracic outlet during a provocative position. In this test, the arms are placed in 90 degrees of abduction and external rotation with the elbows flexed, and the patient repeatedly opens and closes the hands. That sustained elevated position plus rapid hand movements increases demand on the neurovascular structures passing through the thoracic outlet, so if there is compression, symptoms such as numbness, tingling, weakness, or fatigue will be reproduced. This specific sequence—holding the arms in abduction and external rotation and performing repeated hand openings—is classic for the Roos test (often described as an Elevated Arm Stress Test in some sources).

Other maneuvers probe different parts of the outlet: Adson’s test brings in neck extension and head rotation with deep inspiration to stress the scalene triangle; a diminished pulse or reproduced symptoms suggests scalene compression. Wright’s test uses hyperabduction to stress the space under the pectoralis minor; pulse changes or symptoms imply compression there. The described hand-opening, sustained-abduction maneuver is what distinguishes Roos from those other tests.