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

Why This Matters

Differentiating between shoulder impingement and cervical radiculopathy can be clinically challenging, especially in patients presenting with acute shoulder pain. Cervical spine disorders often present as shoulder pain, complicating the diagnostic process. Notably, up to 35% of patients with shoulder impingement syndrome have ipsilateral cervical root compression. A quick, reliable bedside test to distinguish between these two common sources of pain can streamline diagnosis, reduce unnecessary imaging, and improve targeted treatment planning.

What the Research Found

This study evaluated the Swimmer Arm-to-Shoulder (SAS) test as a novel tool for distinguishing between shoulder and cervical spine pathology in patients with unilateral shoulder pain of 12 weeks or less. Among 718 patients aged 40 to 65, 288 were diagnosed with shoulder pathology and 430 with cervical pathology based on clinical, electromyography, and radiologic assessment.

The SAS test demonstrated high diagnostic performance:

      • Sensitivity: 89.2%
      • Specificity: 96.1%
      • Positive Predictive Value: 93.8%
      • Negative Predictive Value: 93.0%
      • Overall Accuracy: 93.3%

     

  • These metrics suggest that the SAS test is both a reliable screening and confirmatory tool for early differentiation of shoulder vs. cervical spine conditions.

Clinical Takeaways

    • Use the SAS test in primary care or outpatient musculoskeletal settings for patients presenting with acute shoulder pain.

    • A positive SAS test supports shoulder impingement diagnosis, while a negative result may suggest cervical radiculopathy.

    • The test can reduce diagnostic uncertainty and guide more appropriate imaging and referrals.

    • Recognize that up to 35% of patients with shoulder impingement may also have cervical root involvement, which underscores the importance of a comprehensive evaluation.

    • Co-management strategies involving multidisciplinary teams may enhance outcomes in patients with overlapping shoulder and cervical spine conditions.

Where Collaborative Spine Care May Support This

Manual therapy providers, such as chiropractors and physical therapists, can incorporate the SAS test during initial assessments to aid in appropriate referral or co-management strategies for shoulder and neck-related pain. Their expertise may be particularly valuable in managing cases with overlapping cervical and shoulder involvement, ensuring a more holistic treatment approach.

Reference
Hamoud H, Aly H, Elmotaleb YA, et al. Swimmer arm-to-shoulder test for early differentiation between shoulder and cervical spine pathology in patients with shoulder pain. BMC Musculoskelet Disord. 2024;25:940. https://doi.org/10.1186/s12891-024-07233-z.

View on Pubmed:  https://pubmed.ncbi.nlm.nih.gov/38942625/

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 Shoulder pain, Cervical spine, Provocative tests, Shoulder impingement Link