Diagnosis and relation to general health of shoulder disorders presenting to primary care

Östör, A.; Richards, C.; Prevost, A. Toby; Speed, Cathy; Hazleman, B. L.

doi:10.1093/rheumatology/keh598

Cited by 313 publications

(177 citation statements)

References 28 publications

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“…1 Rotator cuff tears can result in considerable pain, functional disability, reduced quality of life and loss of independence. [2][3][4] They may also result in loss of productivity and high costs of associated workrelated compensation for those unable to continue in high-demand occupations.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Forty to 60 year old participants were recruited for this study to reflect the reported peak age for SSI (Ostor et al, 2005;van der Windt et al, 1995). Symptom free volunteers as well as people with unilateral shoulder pain completed a screening questionnaire to determine their eligibility for this study.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…S Lewis et al, 2001;Michener et al, 2003). Forty to 60 years of age is reported as the peak age for SSI (Ostor, Richards, Prevost, Speed, & Hazleman, 2005;van der Windt, Koes, de Jong, & Bouter, 1995) with an increased prevalence of these symptoms reported in occupations and athletes who perform frequent overhead activities (P.M. Ludewig & Cook, 2000).…”

Section: Introductionmentioning

confidence: 99%

Clinical assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population?

Land

Gordon

Watt

2017

Musculoskeletal Science and Practice

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1Background: To date, the significance of factors purported to be associated with subacromial shoulder impingement (SSI) and what differences, if any, are present in those with SSI compared to a matched asymptomatic population has not been identified. Gaining information about differences between people with SSI and asymptomatic people may direct clinicians towards treatments that impact upon these differences. Method: Fifty one SSI cases and 51 asymptomatic controls were matched for age, gender, hand dominance and physical activity level. The suggested associated factors were measured bilaterally. Independent t-tests were used to compare each of these measurements between the groups. Any variables for which a significant difference was identified, were then included in a conditional logistic regression analysis to identify independent predictors of SSI. Level of Evidence:Level 3a

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“…Forty to 60 year old participants were recruited to reflect the reported peak age for shoulder impingement (Ostor, Richards, Prevost, Speed, & Hazleman, 2005;van der Windt, Koes, de Jong, & Bouter, 1995). Symptom free volunteers as well as people with unilateral shoulder pain completed a screening questionnaire to determine their eligibility for this study.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

Land

Gordon

Watt

2017

Musculoskeletal Science and Practice

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Background: Current conservative management of subacromial shoulder impingement (SSI) includes generic strengthening exercises, especially for internal (IR) and external (ER) shoulder rotators. However, there is no evidence that the strength or the ratio of strength between these muscle groups is different between those with SSI (cases) and an asymptomatic population (controls).Objective: To identify if isokinetic rotator cuff strength or the ratio of strength is significantly different between cases and controls.Study Design: Case Control Study.Method: Fifty one cases with SSI and 51 asymptomatic controls matched for age, gender, hand dominance and physical activity level completed isokinetic peak torque glenohumeral IR and ER testing. Within the SSI group, 31 dominant limbs were symptomatic and 20 non-dominant limbs were symptomatic. IR and ER were measured separately using continuous reciprocal concentric (con) and eccentric (ecc) contraction cycles at a speed of 60 0 degrees per second and again at 120 0 degrees per second. Values of peak torque (PT), relative peak torque (RPT) and ratios were compared using independent t-tests between the SSI and asymptomatic groups.Results: Significant strength differences between the two groups were present only when the symptomatic SSI shoulder was the dominant shoulder (con ER PT at 60 0 /second, ecc ER PT at 120 0 /second, ecc ER RPT at 120 0 /second and ecc IR PT at 60 0 /second and 120 0 /second). Conclusions:Changes in rotator cuff strength in SSI may be related to limb dominance, which may have implications for strengthening regimes. Level of Evidence:Level 3a

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Diagnosis and relation to general health of shoulder disorders presenting to primary care

Abstract: Shoulder pain, most commonly due to rotator cuff tendinopathy, is associated with significantly reduced health when measured by both specific and generic means. Effort towards prevention and early intervention in these complaints is warranted.

Cited by 313 publications

References 28 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 assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population?

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

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