Arm squeeze test: a new clinical test for differential diagnosis between cervical spine and shoulder disorders.

Introduction 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 (biceps area). Our hypothesis is that squeezing is responsible for pain only in patients with cervico-brachialgy. Materials and methods 1567 patients were included in this study. Diagnosis was clinically and strumentally formulated before performing the test and patients were subdivided as it follows; 903 with rotator cuff tear, 155 with primary shoulder adhesive capsulitis, 101 with arthropathy of acromioclavicular (AC) joint, 55 with calcifying tendonitis, and 48 affected by gleno-humeral arthritis. The study sample included 305 patients with cervico-brachialgy involving one or both shoulders. 350 healthy were recruited as controls. The test was positive when the score on a VAS Scale was 3 points or higher on pressure on the middle third of the upper arm compared with to the AC joint and anterolateral subacromial area. Results The test was positive in 295/305 (96.7%) of patients with cervical spine disorders, compared to 35/903 (3.87%), 3/155 (1.93%), 0/101 (0%), 1/55 (1.81%), 4/48 (8.33%), and of those with rotator cuff tear, adhesive capsulitis, AC arthropaty, calcifying tendonitis and glenohumeral, respectively. A positive result was obtained in 14/350 asymptomatic subjects (4%). If cervicobrachialgy was compared to the other five conditions, the test had a sensitivity from 0.97 to 0.99 and a specificity from 0.93 to 0.99. Respect to controls, the sensitivity was 0.98 and the specificity was 0.97. Discussion In case of shoulder pain, differential diagnosis between cervical and shoulder pathology can be difficult. Conclusions The Arm Squeeze Test may be useful to distinguish a cervico-brachialgy from shoulder disease in case of doubtful diagnosis.