Noninvasive Discrimination of Brachial Plexus Involvement In Upper Limb Pain

Selvaratnam, Peter; Matyas, Thomas A.; Glasgow, Eric

doi:10.1097/00007632-199401000-00006

Cited by 60 publications

(27 citation statements)

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“…We excluded 354 studies on the basis of their titles and abstracts. We then retrieved and reviewed 12 full reports for possible inclusion [4,19,21,35,42,48,51,55,59,60,62,63]. Four studies were excluded because they examined either reliability or repeatability of the test, but not diagnostic accuracy [4,19,35,48].…”

Section: Data Synthesismentioning

confidence: 99%

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

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Section: Data Synthesismentioning

confidence: 99%

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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“…Shoulder disorders can be divided into two groups based on patient's age, with older patients generally suffering from more degenerative conditions and younger patients suffering more from traumatic, inflammatory, or instability diseases [3,8,13]. It is recommended to examine active and passive joint motion and evaluation of strength, thus, it is necessary to perform specific clinical tests for rotator cuff tears and for all other pathologies not related to cervical spine disorders [3,8,13,18]. As final step, X-ray or MRI of the shoulder are obtained to confirm the diagnosis and to quantify the severity of the lesion.…”

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria were represented by: patients younger 35 or older 66 years old; patients with shoulder instability, suprascapular nerve entrapment, os acromiale, insulindependent diabetes, rheumatoid or serum-negative arthritis; patients who already received any treatment for the shoulder pain, previous traumatic injuries to shoulder girdle or column spine. As gold standard to obtain the diagnostic values of the Arm Squeeze Test, diagnosis of cervical nerve root compression (at least one) from C5 to T1 was based on clinical examination of the cervical spine, of the shoulder and of the upper limb; electromyography (for C5 to T1 roots); X-rays (AP and lateral view); MRI of the cervical spine [7][8][9]. The clinical examination of cervical column provides assessment of range of motion, bicipital (C5), brachioradial (C6), tricipital (C7) tendon reflexes and assessment of strength.…”

Section: Methodsmentioning

confidence: 99%

“…false negatives); likelihood ratios for a normal test result was calculated as sensitivity/(1 -specificity); likelihood ratios for an abnormal test result was calculated as (1 -sensitivity)/specificity. The gold standard to obtain the diagnostic values of the Arm Squeeze Test was measured by evaluating clinical examination of the cervical spine, of the shoulder and of the upper limb; electromyography (for C5 to T1 roots); X-rays (AP and lateral view); MRI of the cervical spine [7][8][9]. Intra (repetition of test three times per author) and inter tester (between senior and junior) reliability of the Arm Squeeze Test was determined by use of a k correlation, which is used with categorical and nominal data.…”

Section: Methodsmentioning

confidence: 99%

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Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain

et al. 2013

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Purpose Objective of this study is to evaluate the diagnostic values of the Arm Squeeze Test. The test consists in squeezing the middle third of the upper arm. Methods 1,567 patients were included in this study. Diagnosis of cervical nerve root compression or shoulder disease was clinically formulated and confirmed with imaging before performing test. 350 healthy volunteers were recruited as controls. The test was positive when score on a VAS Scale was 3 points or higher on squeezing the middle third of the upper arm compared to acromioclavicular (AC) joint and anterolateral-subacromial area. Results Patients were subdivided as follows: 903 with rotator cuff tear, 155 with shoulder adhesive capsulitis, 101 with AC joint arthropathy, 55 with calcifying tendonitis, and 48 affected by glenohumeral arthritis. The study sample included 305 patients with cervical nerve root compression from C5 to T1 with shoulder radicular pain. The test was positive in 295/305 (96.7 %) of patients with cervical nerve root compression, compared to 35/903 (3.87 %), 3/155 (1.93 %), 0/101 (0 %), 1/55 (1.81 %) and 4/48 (8.33 %) of those with rotator cuff tear, adhesive capsulitis, AC arthropathy, calcifying tendonitis and glenohumeral arthritis, respectively. A positive result was obtained in 14/350 asymptomatic subjects (4 %). If patients with cervical nerve root compression were compared to controls and patients with shoulder diseases, the test had sensitivity of 0.96 and specificity from 0.91 to 1.Conclusions The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.

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“…The test began with shoulder girdle depression and proceeded through shoulder abduction to 90 , shoulder lateral flexion, forearm supination, wrist and finger extension, and elbow extension. 49 The test was stopped at the first report of neural type pain in the C5 and C6 nerve roots. If the test was stopped during elbow extension, the amount of elbow extension lag (degrees off full elbow extension) was visually estimated.…”

Section: Trigger Point Assessmentmentioning

confidence: 99%

An Exploratory Study to Determine the Relationship between Cervical Dysfunction and Perimenstrual Migraines

Horwitz

Stewart

2015

Physiotherapy Canada

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Purpose: To determine whether an association between cervical dysfunction and perimenstrual migraines exists. Methods: Forty perimenstrual migraine sufferers and 46 controls were compared. Information on the participants' ages and perceptions of neck pain and stiffness were solicited. The blinded physical examination of the cervical area consisted of postural, range of motion, muscle strength, muscle length, trigger point, neural mobility, and segmental cervical joint movement assessment. Results: The migraine group had increased perception of neck pain and stiffness (p < 0.001); reduced bilateral rotation (p ¼ 0.013); decreased muscle length in both trapezii, left sternocleidomastoid, and right occipitals (p ¼ 0.045); more pain on muscle stretch in both levator scapulae, both trapezii, left sternocleidomastoid, and both occipitals (p ¼ 0.013); increased trigger points bilaterally in the left trapezius (p ¼ 0.021), right trapezius (p ¼ 0.023), left sternocleidomastoid (p ¼ 0.0.004), and right sternocleidomastoid (p ¼ 0.021); reduced neural mobility with bilateral elbow lag (p ¼ 0.043); greater C4-C6 pain (p ¼ 0.045); and increased cervical stiffness in C5-C7 (p ¼ 0.023). There were no differences in posture and muscle strength. Decreased muscle length increased the risk of perimenstrual migraines 2.4-6.7 fold, reduced neural mobility 5.8-10.7 fold, and increased C7 stiffness 17.0 fold. Conclusion: The results suggest that an association between cervical dysfunction and perimenstrual headaches should be further explored.Key Words: cervical pain; headache; menstruation; migraine disorders. RÉ SUMÉObjectif : Cette é tude visait à dé terminer s'il y a un lien entre la dysfonction cervicale et les migraines pé rimenstruelles. Mé thodes : On a comparé 40 femmes souffrant de migraines pé rimenstruelles à 46 té moins. On a ré uni de l'information sur l'â ge des participantes et les perceptions de la douleur et de la raideur dans le cou. L'examen mé dical à l'insu de la ré gion cervicale a consisté à é valuer la posture, l'amplitude du mouvement, la force musculaire, la longueur des muscles, le point de dé clenchement, la mobilité neurale et le mouvement de l'articulation cervicale segmentaire. Ré sultats : Les patientes souffrant de migraines avaient une perception accrue de la douleur et de la raideur dans le cou (p < 0,001), une rotation bilaté rale ré duite (p ¼ 0,013); elles pré sentaient une diminution de la longueur musculaire au niveau des deux trapè zes, du sternoclé idomastoïdien gauche et des occipitaux droits (p ¼ 0,045); ressentaient plus de douleur à l'é tirement musculaire au niveau des deux muscles é lé vateurs de la scapula, des deux trapè zes, du sternoclé idomastoïdien gauche et des deux occipitaux (p ¼ 0,013); une é lé vation des points de dé clenchement des deux cô té s dans le trapè ze gauche (p ¼ 0,021), le trapè ze droit (p ¼ 0,023), le sternoclé idomastoïdien gauche (p ¼ 0,0004) et le sternoclé idomastoïdien droit (p ¼ 0,021); une ré duction de la mobilité neurale avec latence du coude de...

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Noninvasive Discrimination of Brachial Plexus Involvement In Upper Limb Pain

Cited by 60 publications

References 0 publications

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain

An Exploratory Study to Determine the Relationship between Cervical Dysfunction and Perimenstrual Migraines

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