An Analysis of the Diagnostic Accuracy of the Hawkins and Neer Subacromial Impingement Signs

MacDonald, Peter B.; Clark, Peter; Sutherland, Kelly

doi:10.1097/00042752-199904000-00020

Cited by 49 publications

(84 citation statements)

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“…A number of other pathologies including subacromial bursa pathology were also identified on ultrasound in the group with a MLM rotator cuff tear and it is possible that provocation of symptoms from coexisting pathology may explain the lack of test specificity for a MLM rotator cuff tear in this cohort. Our results do support previous findings in which a positive external rotation lag sign was reported to be highly specific for a rotator cuff tear 29,42 closer inspection of these study results reveals that a negative Hawkins-Kennedy test resulted in only a small change (reduction) in posttest probability of a partial or full thickness rotator cuff tear from 28% (pre-test probability) to 11% (post-test probability) in one study, 29 and resulted in negative predictive values of only 50% for Stage 2 impingement (including partial thickness tears) in the other study. 42 No CIs were reported for estimates of diagnostic accuracy in either study, hence the findings of these studies should be interpreted with caution.…”

Section: Discussionsupporting

confidence: 92%

“…28,30,31,42 The majority of previous diagnostic accuracy studies in this area involved patients recruited primarily from surgical waiting lists and investigated only a small number of predominantly physical examination tests, reporting variable accuracy findings. 26,29,32,38,64 Only a limited number of studies estimated the diagnostic accuracy of patient history variables for identifying rotator cuff tears. 28,30,65 Our results support findings from these studies in which older age and the presence of night pain were found to be strong predictors of a rotator cuff tear.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of previous studies have estimated the diagnostic accuracy of a small number of physical examination tests for identifying rotator cuff tears. [26][27][28][29][30][31] Although 'lag' signs have shown consistently high levels of specificity (88-98%) for large rotator cuff tears in a number of studies, [30][31][32][33][34][35][36][37][38] 28,30,31,43 Yet such questions and tests may provide important information that might enhance the ability of the primary care clinician to diagnose MLM rotator cuff tears. Population differences, methodological concerns and lack of investigation of comprehensive clinical examination variables in previous studies mean the accuracy of the clinical diagnosis of MLM rotator cuff tears in primary care remains largely unknown.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Cadogan

McNair

Laslett

et al. 2013

Journal of Manual & Manipulative Therapy

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Objectives: Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Methods: Participants were consecutively recruited from primary health care practices (n5203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P,0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated. Results: A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86-1.00; negative likelihood ratio: 0.00, 95% CI: 0.00-0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86-0.95; positive likelihood ratio 4.66, 95% CI: 2.34-8.74). Discussion: Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Cadogan

McNair

Laslett

et al. 2013

Journal of Manual & Manipulative Therapy

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“…Examining patients with shoulder problems can be challenging because (1) shoulder motion involves a complex interaction of movement of the scapula on the thorax, the humeral head on the glenoid, and the clavicle at the acromioclavicular and sternoclavicular joints [6,13,24]; and (2) physical examination tests for the shoulder are sensitive but not specific for one particular shoulder condition [4,5,10,20,23,26,[29][30][31]. It is important clinicians understand the limitations of physical examination tests when evaluating patients with shoulder pain.…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation of the Shoulder Shrug Sign

Jia

Petersen

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The ''shrug sign'' (inability to lift the arm to 90°abduction without elevating the whole scapula or shoulder girdle) has been associated with a diagnosis of rotator cuff disease. Based on our clinical experience, we hypothesized the shrug sign is not a specific diagnostic sign for this condition, but rather is associated with various shoulder conditions and shoulder weakness and loss of range of motion. We retrospectively reviewed 982 consecutive patients who had been examined preoperatively for the shrug sign. A positive shrug sign was present in 51.3% of the patients, and the average distance lost from the horizontal was 20.5°± 2.2°(standard error of mean). Increasing age was associated with the presence of a shrug sign. The highest incidence was in patients with adhesive capsulitis (94.7%). The shrug sign was not sensitive for tendinosis, partial rotator cuff tears, or full-thickness or massive rotator cuff tears. The shrug sign was associated with weakness in abduction, night pain, and loss of range of motion, especially passive abduction. Although the shrug sign is useful as a general sign of shoulder abnormality, particularly when associated with stiffness, it was not specific or sensitive for rotator cuff problems.

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“…The theory of several of these is to stress the tissues thought to be involved in the pain-generating mechanism, for example; Neer impingement sign (Neer 1972;Neer 1983), Hawkins-Kennedy impingement test (Hawkins & Kennedy 1980), the Patte maneuver (Leroux et al, 1995) and Jobe supraspinatus test (Jobe & Moynes 1982). Their different ability to produce pain by provoking subacromial structures has been validated in several earlier studies (Sigholm & Styf 1988;Leroux et al, 1995;Çaliş et al, 2000;MacDonald et al, 2000;Valadie et al, 2000;Holtby & Razmjou 2004;Park et al, 2005) and appropriate sensitivity was reported, but less specificity which affects their structural discriminating ability. However, the knowledge about their reliability aspects is limited.…”

Section: Introductionmentioning

confidence: 99%

Intra- and interexaminer reliability of four manual shoulder maneuvers used to identify subacromial pain

Johansson¹,

Ivarson²

2009

Manual Therapy

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Introduction: Shoulder pain is a diagnostic challenge and the physical clinical examination of the shoulder is crucial. It is important that the diagnostic tests used are valid as well as reliable.Objective: The objective of the study was to assess intra-and interexaminer reliability for four manual shoulder maneuvers; the Neer impingement sign, the Hawkins-Kennedy impingement test, the Patte maneuver, the Jobe supraspinatus test. These maneuvers are frequently used in clinical practice to examine patients with shoulder complaints in which subacromial pain is highly suspected.Methods: Thirty-three participants with shoulder pain were included consecutively. Within a week from inclusion, the four maneuvers were performed by a physiotherapist. The procedure was standardized in order to increase reproducibility. After a week, the maneuvers were performed again by the same physical therapist (test-retest) and by another physical therapist (test for interexaminer reliability). Results

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An Analysis of the Diagnostic Accuracy of the Hawkins and Neer Subacromial Impingement Signs

Cited by 49 publications

References 0 publications

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Clinical Evaluation of the Shoulder Shrug Sign

Intra- and interexaminer reliability of four manual shoulder maneuvers used to identify subacromial pain

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