Arm Squeeze Test
- Fysiobasen
- Oct 4
- 3 min read
The Arm Squeeze Test is a clinical examination used to differentiate between cervical nerve root compression and shoulder pathology when the diagnosis is uncertain¹. The principle is that compression of the middle third of the upper arm will reproduce pain in cases of cervical radiculopathy, but typically not in isolated shoulder disease.
Relevant Anatomy
The cervical nerves exit from the cervical spine (C1–C8) and form the brachial plexus, which innervates the shoulder and upper limb².
The most relevant nerves tested in this examination include:
Musculocutaneous nerve (C5–C7)
Radial nerve (C5–T1)
Ulnar nerve (C7–T1)
Median nerve (C5–T1)
When these nerves are compressed at the cervical level, pain and neurological symptoms may be triggered.
Purpose
The test helps distinguish cervical radiculopathy from shoulder pathology:
In cervical root compression (C5–T1): Moderate compression of the mid-arm provokes significant pain.
In shoulder disease (e.g., rotator cuff tear, AC joint arthrosis): Compression usually does not reproduce pain¹.
Technique
The examination is simple and quick to perform. The examiner stands behind the patient and places the thumb on the triceps and the fingers on the biceps to compress the middle third of the upper arm with moderate force¹.
After compression, the patient is asked to rate the pain on a visual analogue scale (VAS). This score is compared to the discomfort produced when pressure is applied to the AC joint and the subacromial region.
A positive test is present if the patient reports a pain score of ≥3 on the VAS during arm compression, which is significantly greater than the pain elicited at the AC joint or subacromial space¹,⁴.
Diagnostic Accuracy
Research demonstrates that the Arm Squeeze Test has excellent diagnostic reliability.
In a landmark study by Gumina et al., the test was performed on more than 1,500 participants, including patients with cervical radiculopathy, rotator cuff tears, and healthy controls. The results showed that the Arm Squeeze Test is a powerful tool for distinguishing cervical pain from shoulder-related pathology¹.
Clinical Implications
The Arm Squeeze Test should not be used in isolation but interpreted together with the clinical picture and other tests. A systematic review concluded that the highest diagnostic value is achieved when the test is combined with:
Spurling’s Test
Upper Limb Neural Tension Test
Shoulder Abduction Test (Bakody Sign)
Cervical Traction Test⁵
In practice:
A positive Arm Squeeze Test, together with a positive Spurling’s and Traction Test, strongly supports the diagnosis of cervical radiculopathy.
Conversely, a negative Arm Squeeze Test and a negative ULNTT make cervical radiculopathy less likely⁵.
Summary
The Arm Squeeze Test is a fast, non-invasive, and accurate method for differentiating between cervical nerve root compression and shoulder disorders. With its high sensitivity and specificity, it is especially valuable in patients presenting with non-specific shoulder pain where the clinical origin of symptoms is uncertain. When combined with other cervical and shoulder tests, it provides strong diagnostic accuracy and supports clinical decision-making.
References
Gumina S, Carbone S, Albino P, Gurzi M, Postacchini F. Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain. European Spine Journal, 2013;1558–1563.
Joshua W, Vamsi R, Bruno B.Anatomy, Head and Neck, Cervical Nerves. StatPearls.
Strongerdadproject. Arm Squeeze Test. Available from:https://www.youtube.com/watch?v=JS-dphAKL8Y [last accessed 29/9/2023]
Joshua C, Shane K, Jonathan S. Netter's Orthopaedic Clinical Examination. USA: Elsevier, 2015.
Thoomes, E. J., van Geest, S., van der Windt, D. A., Falla, D., Verhagen, A. P., Koes, B. W., Thoomes-de Graaf, M., Kuijper, B., Scholten-Peeters, W. G. M., & Vleggeert-Lankamp, C. L. (2018). Value of physical tests in diagnosing cervical radiculopathy: a systematic review. The spine journal : official journal of the North American Spine Society, 18(1), 179–189. https://doi.org/10.1016/j.spinee.2017.08.241
