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

Abstract

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.

Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study

“…Most diagnoses in the shoulder are based on the history and clinical examination alone and there is no objective gold standard to compare to for the most common diagnoses (39,40). The diagnoses osteoarthritis and full thickness rotator cuff tears require corresponding findings on imaging (41). We used a standardised diagnostic routine to identify the point prevalence of musculoskeletal diagnoses (appendix 1).…”

Effects of Postural Education and Physical Activity on UCLA Evaluation and Health Status in Adults from Chile: An Intervention Program

“…This joint pain is usually persistent, producing a high disability in work activity and daily life. Furthermore, it is a major burden on health resources in Spain and leads to lost productivity due to absenteeism, as shown by Cadogan et al [33]. For these reasons, it is essential to develop intervention programs aimed to prevent these kind of pathologies as well as treat them [34].…”

Evaluation and Management of Rotator Cuff Tears: a Primary Care Perspective

“…Early identification of full-thickness and medium-to-largesized partial-thickness rotator cuff tears is important for primary care providers, as early identification will aid in optimizing outcomes (e.g., advanced imaging and surgical referral) [4]. The key for primary care providers in order to facilitate prompt identification of these injuries is obtaining a detailed history and performing an appropriate physical examination.…”

“…The key for primary care providers in order to facilitate prompt identification of these injuries is obtaining a detailed history and performing an appropriate physical examination. Studies have shown that a history of nighttime pain, consistent pain, and older age are predictors of rotator cuff tears [4,5]. Co-morbidities including diabetes mellitus, high body mass index, oral corticosteroid use, Achilles tendinitis, carpal tunnel syndrome, and trigger finger have been associated with rotator cuff disease [6].…”

“…The physical examination for assessing the integrity of the rotator cuff can prove challenging. The sensitivity and specificity for each maneuver is variable; thus, synthesizing the information from each of the examination components is imperative in order to optimize diagnostic accuracy [4]. Although the examination is an important component to the evaluation of the rotator cuff, clinicians should have a low threshold for diagnostic imaging (i.e., ultrasonography or MRI) due to limited predictive values of the history and examination [8].…”