Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis

Purpose Patients with adhesive capsulitis were clinically evaluated for establishing whether pain elicited by pressure on the coracoid area, which is just above the anatomical structures involved in the disease, may be considered a pathognomonic sign of this condition. Material and Methods The study group included 85 patients with primary adhesive capsulitis, 465 with rotator cuff tear, 48 with calcifying tendonitis, 16 with glenohumeral arthritis, 66 with acromioclavicular arthropathy and 150 asymptomatic subjects. We aimed at evaluating whether digital pressure on the coracoid area evocated pain. Digital pressure was also carried out on the acromioclavicular joint and the anterolateral subacromial area. The test was considered positive when pain on the coracoid region was more severe by 3 points or more (VAS scale) with respect to other areas. Results The test was positive in 96,4% of patients with adhesive capsulitis. In rotator cuff tear, calcifying tendonitis, glenohumeral and acromioclavicular arthritis a positive test was found in 11,1%, 14,5%, 6,2% and 10,6% of patients, respectively. A positive result was obtained in 3/150 normal subiects (2%). If adhesive capsulitis was compared to the other four conditions, the test had a sensitivity of 0,96 and a specificity from 0,87 to 0,89. Respect to controls, the sensitivity and specificity was 0,99 and 0,98. Conclusion Because this test is very specific and sensitive, it may be used to confirm or exclude diagnosis of adhesive capsulitis. The coracoid pain test could be considered as a pathognomonic sign in physical examination of patients with stiff and painful shoulder.