Shoulder pain often poses a challenge for clinicians to determine whether the symptoms are arising from local pathology vs. referral from the cervical spine…or both.
The Arm Squeeze Test can help differentiate arm pain arising from cervical nerve root irritation vs. that of shoulder origin. The test is performed when the clinician stands behind the patient and uses both hands to clasp and squeeze the middle third of the upper arm with enough force to create moderate compression of the underlying muscle. Reproduction of arm pain (rated at least VAS 3 on a 0-10 scale) during compression suggests a cervical origin. The rationale is that compression provokes a response from the relatively superficial peripheral nerves (musculocutaneous, radial, ulnar and median) that arise from hypersensitized lower cervical nerve roots (C5-T1).
In a study of over 1500 patients with arm pain, the Arm Squeeze test showed very high sensitivity (97%), specificity (>91%) and inter/ intraobserver reliability. (1) The test was positive in 97% of patients with confirmed cervical nerve root compression and only 2-4% of those with rotator cuff tear, adhesive capsulitis, A/C osteoarthritis and control subjects.
1. Gumina S, Carbone S, Albino P et al. Arm squeeze test: a new clinical test to distinguish neck from shoulder pain. European Spine Journal 2013; 22: 1558-63.
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