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. 2024 Nov 21;25(1):940.
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

Hesham Hamoud  1 , Hany Aly  2 , Yasser A Elmotaleb  2 , Mohamad M Ghit  2 , Ahmad Mosalam  3 , Tarek M Nasrallah  4 , Saad M El Zokm  4 , Ibrahim Fawzy  2 , Abdelwahab N Bayoumy  2 , Maha S Mohamed  2 , Seham A Elazab  2 , Amal M Elmesiry  2 , Eman A Rageh  2 , Mai A Moussa  2 , Ahmed Elyasaki  5 , Sherif Refaat  6 , Ahmed M Elhilasy  7 , Ahmed M El Deeb  8 , Walid Elshaitany  9 , Ashraf Eltabiey  10
Affiliations

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

Hesham Hamoud et al. BMC Musculoskelet Disord. .

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.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Protocol of the present study was approved by the ethical committee of Al-Azhar Faculty of Medicine and all participants provided informed consent in accordance with the Helsinki Declaration on clinical research involving human subjects. Consent for publication: NA. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Steps of the swimmer arm-to-shoulder test: A Starting position (arm beside the torso with elbow flexion 90○), B Arm Abduction 90○, C Swimmer strike, D Shoulder touch with hypothenar eminence
See this image and copyright information in PMC

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