Abstract
Purpose
Objective of this study is to evaluate the diagnostic values of the Arm Squeeze Test. The test consists in squeezing the middle third of the upper arm.
Methods
1,567 patients were included in this study. Diagnosis of cervical nerve root compression or shoulder disease was clinically formulated and confirmed with imaging before performing test. 350 healthy volunteers were recruited as controls. The test was positive when score on a VAS Scale was 3 points or higher on squeezing the middle third of the upper arm compared to acromioclavicular (AC) joint and anterolateral-subacromial area.
Results
Patients were subdivided as follows: 903 with rotator cuff tear, 155 with shoulder adhesive capsulitis, 101 with AC joint arthropathy, 55 with calcifying tendonitis, and 48 affected by glenohumeral arthritis. The study sample included 305 patients with cervical nerve root compression from C5 to T1 with shoulder radicular pain. The test was positive in 295/305 (96.7 %) of patients with cervical nerve root compression, compared to 35/903 (3.87 %), 3/155 (1.93 %), 0/101 (0 %), 1/55 (1.81 %) and 4/48 (8.33 %) of those with rotator cuff tear, adhesive capsulitis, AC arthropathy, calcifying tendonitis and glenohumeral arthritis, respectively. A positive result was obtained in 14/350 asymptomatic subjects (4 %). If patients with cervical nerve root compression were compared to controls and patients with shoulder diseases, the test had sensitivity of 0.96 and specificity from 0.91 to 1.
Conclusions
The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.
Similar content being viewed by others
References
Borenstein DG, Wiesel SW, Boden SD (1996) Neck Pain: Medical Diagnosis and Comprehensive Management. Saunders, Philadelphia
Katz JS, Saperstein DS, Wolfe G, Nations SP, Alkhersam H, Amato AA, Barohon RJ (2001) Cervicobrachial involvement in diabetic radiculoplexopathy. Muscle Nerve 24:794–798. doi:10.1002/mus.1071
McFarland EG (2006) Examination of the shoulder. Thieme, New York
Gorski JM, Schwartz LH (2003) Shoulder impingement presenting as neck pain. J Bone Joint Surg 85:635–638
Mamula CJ, Erhard RE, Piva SR (2005) Cervical radiculopathy or Parsonage-Turner syndrome: differential diagnosis of a patient with neck and upper extremity symptoms. J Orthop Sports Phys Ther 35:659–664
Tsiptsios I, Fotiou F, Sitzoglou K, Fountoulakis KN (2001) Neurophysiological investigation of cervical spondylosis. Electromyogr Clin Neurophysiol 4:305–313
Reider B (2001) The orthopaedic physical examination. W. B. Saunders Company, Philadelphia
Selvaratnam PJ, Matyas TA, Glasgow EF (1994) Noninvasive discrimination of brachial 217 plexus involvement in upper limb pain. Spine 19:26–33
Yung E, Asavasopon S, Godges J (2010) Screening for head, neck, and shoulder pathology in patients with upper extremity signs and symptoms. J Hand Ther 23:173–186. doi:10.1016/j.jht.2009.11.004
Rockwood CA (2009) The shoulder, 4th edn. W. B. Saunders, Philadelphia
Sackett DL, Haynes RB (2002) The architecture of diagnostic research. BMJ 324:539–541
Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460
Pateder DB, Berg JH, Thal R (2009) Neck and shoulder pain: differentiating cervical spine pathology from shoulder pathology. J Surg Orthop Adv 18:170–174
Macnab I, McCulloch J (1994) Neck ache and Shoulder pain. Williams and Wilkins, Baltimore
Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, Guzman J, van der Velde G, Carroll LJ, Holm LW, Côté P, Cassidy JD, Haldeman S (2008) Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000–2010 Task Force on neck pain and its associated disorders. Spine 33(4 Suppl):S101–S122
Wainner RS, Frizt JM, Irrang JJ, Boninger ML, Delitto A, Allison S (2003) Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 28:52–62
Hoppenfield S (1976) Examinations of the spine and extremities. Prentice-Hall, New York
Gumina S, Carbone S, Arceri V, Rita A, Vestri AM, Postacchini F (2009) The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain. BMC Musculoskelet Disord 10:157–165. doi:10.1186/1471-2474-10-157
Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC (2007) A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 16:307–319. doi:10.1007/s00586-006-0225-6
Tong HC, Haig AJ, Yamakawa K (2002) The spurling test and cervical radiculopathy. Spine 27:156–159
Reilly PA, Littlejohn GO (1990) The brachial plexus tension test of Elvey. Br J Rheumatol 29:234–235
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gumina, S., Carbone, S., Albino, P. et al. Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain. Eur Spine J 22, 1558–1563 (2013). https://doi.org/10.1007/s00586-013-2788-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2788-3