1īlood tests (for example full blood count and erythrocyte sedimentation rate) may be indicated in the presence of red flags, for example, where an inflammatory process is suspected. 1 Tests to identify the specific tendon or muscle affected have a questionable utility in clinical practice due to poor diagnostic accuracy. Jobe’s test (resisted elevation with the arm at 90° and the thumb pointing down) has sensitivity and specificity of 77–95% and 65–85% respectively. 1 The painful arc test (pain at mid-range of active abduction) has sensitivity and specificity of 32–97% and 10–80% respectively. Impingement tests include Hawkin’s test (pain on rotating the arm internally while flexed at 90°) with a sensitivity and specificity of 80–92% and 25–60%, respectively. 2 It is also reduced in advanced glenohumeral arthropathy, but no evidence is available for its diagnostic accuracy in primary care. Reduced range of passive external rotation is the principle diagnostic test for contracted frozen shoulder (adhesive capsulitis). The cross adduction test (pain when bringing arms across chest to touch the opposite shoulder) has sensitivity of 77–100% and specificity of 79%. 2 Exclusive tenderness over the joint has a high sensitivity of 90–95%, however it has a poor specificity of 10%. 3Ĭlinical tests to diagnose ACJ disorder are of limited diagnostic value. Spurling’s test (pain when extending and rotating the head to the affected side while pressing down on the head) might further help indicate cervical radiculopathy, with low to moderate sensitivity (30–90%) and high specificity (74–100%). Pain referred from the neck is often associated with neck movement and sometimes with nerve root compression producing paraesthesia, weakness, and altered tendon reflexes.
None of the many specific clinical examination tests suggested for diagnosing shoulder and neck pain has high sensitivity and specificity.
Appendix 1 will help guide diagnosis, treatment, and referral decisions.
The focus should be on the four most common problems.
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