Swimmer arm-to-shoulder test for early differentiation between shoulder and cervical spine pathology in patients with shoulder pain

Abstract

Background Several tests have been suggested for screening and diagnosis of cervical spine and shoulder girdle conditions underlying shoulder pain with variable degrees of clinical accuracy. The present study aimed to test the reliability, clinical benefit and screening value of the Swimmer Arm-to-Shoulder (SAS) test; a new clinical test developed to differentiate shoulder impingement from cervical radiculopathy in patients with shoulder pain of ≤ 12 weeks. Methods The study included 718 patients aged 40–65 years, with unilateral and localized shoulder girdle pain lasting for ≤ 12 weeks. Diagnosis based on clinical, electromyography and radiological findings was considered as the reference gold standard for test assessment. Results Clinical diagnosis identified shoulder pathology in 288 patients (40.1%) and cervical spine pathology in 430 patients (59.9%). SAS test was positive in 274 patients (38.2%). The SAS test proved to be effective in distinguishing shoulder from cervical spine pathology with a sensitivity of 89.2% (95% CI: 85.0-92.6%), specificity of 96.1% (95% CI: 93.8–97.7%), PPV of 93.8% (95% CI: 90.5–96.0%), NPV of 93.0% (95% CI: 90.5–94.9%), LR + of 22.6% (95% CI: 14.1–36.0%), LR- of 0.11 (95% CI: 0.08–0.16) and accuracy of 93.3% (95% CI: 91.2–95.0%). Conclusions SAS test is an easy to perform, patient dependent and reliable as a screening test and diagnosis confirmatory test.