The patient is positioned sitting or supine position.
Ask the patient to make an active or passive abduction of the shoulder, flex the elbow, and place the palm of the hand on the top of the patient head (elevate the arm through abduction, so that the hand or forearm rests on top of the head).
What does a positive Shoulder Abduction Test mean?
Shoulder Abduction Test (Bakody Test) is positive if the symptoms of nerve root irritation improve or resolve, because abduction of the arm decreases the tension of the nerve roots.
A cervical extradural compression problem, such as a herniated disk, or nerve root compression should be suspected.
Sensitivity & Specificity
A study by Davidson 1 found that this test has the following accuracy:
Specificity: 0.75 %
Another study by Wainner 2 to assess the reliability and accuracy of individual clinical examination for the diagnosis of cervical radiculopathy, the Shoulder Abduction Test has a low Sensitivity (17 %) and a high Specificity (92 %).
The specific segmental level can be determined by the dermatome distribution of the symptoms.
The C4–C6 nerve roots are primarily examined in this test.
If the nerve root irritation increases during the course of the above test, one must suspect a thoracic outlet syndrome (due to changes in the scalene muscles or to a cervical rib).
If the symptoms are increased with this maneuver, the implication is that pressure is increasing in the interscalene triangle.
Davidson RI, Dunn EJ, Metzmaker JN. The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compressive monoradiculopathies. Spine (Phila Pa 1976). 1981 Sep-Oct;6(5):441-6. doi: 10.1097/00007632-198109000-00004. PMID: 7302677.
Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003 Jan 1;28(1):52-62. doi: 10.1097/00007632-200301010-00014. PMID: 12544957.
Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007 Mar;16(3):307-19. doi: 10.1007/s00586-006-0225-6. Epub 2006 Sep 30. PMID: 17013656; PMCID: PMC2200707.
Evans RC: Illustrated Essentials in Orthopedic Physical Assessment. St. Louis, MO: Mosby-Year book Inc, 1994.
Clinical Tests for the Musculoskeletal System 3rd Edition.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.