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

Hesham Hamoud; Hany Aly; Yasser A Elmotaleb; Mohamad M Ghit; Ahmad Mosalam; Tarek M Nasrallah; Saad M El Zokm; Ibrahim Fawzy; Abdelwahab N Bayoumy; Maha S Mohamed; Seham A Elazab; Amal M Elmesiry; Eman A Rageh; Mai A Moussa; Ahmed Elyasaki; Sherif Refaat; Ahmed M Elhilasy; Ahmed M El Deeb; Walid Elshaitany; Ashraf Eltabiey

doi:10.1186/s12891-024-08013-9

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

BMC Musculoskelet Disord. 2024 Nov 21;25(1):940. doi: 10.1186/s12891-024-08013-9.

Authors

Hesham Hamoud¹, Hany Aly², Yasser A Elmotaleb², Mohamad M Ghit², Ahmad Mosalam³, Tarek M Nasrallah⁴, Saad M El Zokm⁴, Ibrahim Fawzy², Abdelwahab N Bayoumy², Maha S Mohamed², Seham A Elazab², Amal M Elmesiry², Eman A Rageh², Mai A Moussa², Ahmed Elyasaki⁵, Sherif Refaat⁶, Ahmed M Elhilasy⁷, Ahmed M El Deeb⁸, Walid Elshaitany⁹, Ashraf Eltabiey¹⁰

Affiliations

¹ Rheumatology and Rehabilitation Department, Al-Azhar University, Cairo, Egypt. Hamoud.hesham@yahoo.com.
² Rheumatology and Rehabilitation Department, Al-Azhar University, Cairo, Egypt.
³ Rheumatology and Rehabilitation Department, Al-Azhar University, Assiut, Egypt.
⁴ Rheumatology and Rehabilitation Department, Al-Azhar University, Damietta, Egypt.
⁵ Physical Medicine and Rehabilitation Department, Ain Shams University, Cairo, Egypt.
⁶ Rheumatology and Rehabilitation Department, Mansoura University, Mansoura, Egypt.
⁷ Radiology Department, Ministry of Health, Cairo, Egypt.
⁸ Radiology Department, Al-Azhar University, Cairo, Egypt.
⁹ Orthopedic Department, Benha Scientific Hospital, Benha, Egypt.
¹⁰ Ashraf Eltabiey, Orthopedic Department, Al-Azhar University, Cairo, Egypt.

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.

Keywords: Cervical spine; Provocative tests; Shoulder impingement; Shoulder pain.

MeSH terms

Adult
Aged
Cervical Vertebrae* / diagnostic imaging
Cervical Vertebrae* / pathology
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Radiculopathy / diagnosis
Radiculopathy / physiopathology
Reproducibility of Results
Shoulder Impingement Syndrome / diagnosis
Shoulder Impingement Syndrome / diagnostic imaging
Shoulder Impingement Syndrome / physiopathology
Shoulder Pain* / diagnosis
Shoulder Pain* / etiology
Swimming