Sensitivity of the Roos Test for Thoracic Outlet Syndrome
The Roos test has poor sensitivity (approximately 62-67%) and should not be used as a standalone diagnostic test for thoracic outlet syndrome, with evidence suggesting its use should be discontinued for differential diagnosis of TOS. 1
Test Performance Characteristics
Sensitivity and Specificity Data
The Roos test demonstrates 62% sensitivity and 66% specificity when symptoms occurring during the test are used as the endpoint 2
When ultrasound-confirmed TOS is used as the diagnostic endpoint, sensitivity improves slightly to 67% with 78% specificity using a cutoff of -15 mmHg oxygen pressure drop 2
A 2017 systematic review concluded that Grade C evidence exists recommending discontinuation of the Roos test for differential diagnosis of thoracic outlet syndrome due to inadequate diagnostic accuracy 1
Comparison to Other Provocative Tests
The Roos test performs worse than other provocative maneuvers including the Adson test (PPV 85%), hyperabduction test (PPV 92%), and Wright test 3
Provocative tests in general have mean sensitivity of 72% and specificity of 53%, with the Roos test falling below these averages 3
Using multiple provocative tests in combination improves specificity more effectively than relying on the Roos test alone 3
Clinical Implications and Pitfalls
Test Reliability Issues
The Roos maneuver demonstrates good but imperfect test-retest reliability, partly due to inherent unreliability of the provocation maneuver itself 2
Symptoms reported by history differ from symptoms expressed during the Roos maneuver in one-third of patients, highlighting the test's inconsistency 2
The Roos test should probably be performed at least twice in patients with suspected TOS to improve reliability 2
Diagnostic Approach
The American College of Radiology recommends chest radiography as initial imaging to identify osseous abnormalities such as cervical ribs or first rib anomalies 4
For neurogenic TOS, MRI without IV contrast is sufficient to diagnose compression of neurovascular bundles 4
Doppler ultrasonography is excellent for initial evaluation of venous TOS, showing venous compression during arm abduction 4
Imaging findings must be carefully correlated with clinical symptoms, as venous compression is often present with arm abduction in asymptomatic patients 5
Key Caveat
The Roos test does not allow for exclusive differential diagnosis of TOS and may provoke symptoms in patients with other upper extremity pathology 1
Better diagnostic accuracy is achieved with the Halstead maneuver, Wright's test, Cyriax Release test, and supraclavicular pressure test, though these also do not exclusively diagnose TOS 1