Can clinical tests show high diagnostic accuracy in the assessment of degenerative full-thickness rotator cuff tears?

Abstract

Objectives: At present, the diagnosis of full-thickness rotator cuff tears (FTCTs) relies heavily on imaging. We suggest that clinical examination can reliably be used as a substitute for diagnostic imaging, particularly in relatively older patients who are undergoing conservative management. Our study evaluated the diagnostic value of five clinical tests in assessing FTCT in secondary care. Methods: One hundred and fifteen patients were examined by a consultant shoulder surgeon for suspected FTCT and underwent diagnostic imaging. Clinical examination included the empty-can test, resisted external rotation test, external rotation lag test, belly-press test, and lift-off test. Fifty two (45%) of these patients were referred for shoulder arthroscopy, while the rest were managed conservatively. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of these tests were calculated, comparing clinical results with arthroscopic findings. Results: Our results showed that, in combination, these five special tests have high diagnostic values for FTCT, with an overall accuracy of 90%. Both the empty-can test and the resisted external rotation test had a sensitivity of 97%. While the external rotation lag test had poor accuracy, it was 100% successful at ruling in tears. The belly-press and lift-off tests were 100% sensitive and specific for full-thickness tears of the subscapularis. Conclusion: Clinical tests for diagnosing FTCT have high diagnostic value, comparable to imaging modalities explored in the literature. Overreliance on magnetic resonance imaging and ultrasonography may not be justified, particularly in a relatively older population when a rotator cuff tear repair is not scheduled.