Evaluation of the Clinical Practice of Shoulder Examination among Ten Experienced Shoulder Surgeons

Abstract

Key MessagesAlthough a standardized guideline for a complete shoulder examination is not available, experienced shoulder surgeons showed a high degree of agreement about which SPE tests should be used for 12 most frequent shoulder pathologies. The recommendation of experienced shoulder surgeons could therefore be used as a foundation for standardized guidelines. IntroductionEffective treatment of shoulder pathologies depends on a correct diagnosis. To aid diagnosis at least 184 tests of Shoulder Physical Examination (SPE) have been described [1]. The large number of different tests and gap of knowledge may cause a communication problem between clinicians [2-4]. Large meta-analyses have not been able to suggest a standardized guideline shoulder examination [5,6].In the search of a standardized guideline for shoulder examination, we evaluated the clinical practice of shoulder examination among ten experienced shoulder surgeons. The aim was to identify the most used SPE tests and evaluate the usefulness of these tests in terms of sensitivity and specificity and present the preferred SPE used by experienced shoulder surgeons. Subjects and MethodsThe study was conducted as a questionnaire based survey. The questionnaire was sent to all shoulder surgeons at a specialized arthroscopic centre, Arthroscopic Centre Amager (ACA). ACA is a highly specialized centre for arthroscopic surgery. Ten surgeons are specialized in shoulder arthroscopy and are considered as experts in examination and treatment of shoulder diseases. The period of investigation was March to May 2014. Each of the ten participants received a questionnaire listing the following 12 pathologies and they were asked to name the SPE tests they usually apply to for each of the 12 pathologies. They were able to choose any SPE test they were familiar with and write in the questionnaire, no description to the tests were given to the surgeons. Subsequently, we performed a thorough literature search on Pubmed.com and the Cochrane library to investigate the sensitivity and specificity of the most reported test for each of the following 12 pathologies.The 12 pathologies were: 1) Acromioclavicular joint arthrosis, 2) Subacromial impingement syndrome, 3) Tear/lesion of the supraspinatus tendon, 4) Tear/lesion of the infraspinatus/teres minor tendon, 5) Tear/lesion of the subscapularis tendon, 6) Caput longum biceps pathology, 7) Superior Labrum Anterior-Posterior (SLAP) lesion, 8) Anterior instability, 9) Posterior instability, 10) Multi Directional Instability (MDI), 11) Adhesive capsulitis, and 12) Scapula alatae. ResultsTen out of 10 (100%) shoulder surgeons completed the questionnaire. The mean experience as shoulder surgeon was 10 years (range, 4-22 years). A total of 49 different SPE tests were reported. For HSOA Journal of Orthopedic Research and Physiotherapy Research Article AbstractContext: Shoulder problems constitute a major socioeconomic problem with lifetime prevalence up to 66.7%. To aid the diagnosis more than 184 tests have been described. Although a s...

Physical Examination of the Shoulder in the Rehabilitation Setting: A Review of the Literature

“…The shoulder is the most complex joint of the body reflected by the number of tests and maneuvers that are described to evaluate the shoulder complaints (23). The current review study described 10 out of 184 tests believed to be the most useful ones to evaluate SP in the rehabilitation settings and in accordance with the statements by Ganestam et al (6). To perform an accurate and updated diagnosis, a systematic approach to history and PE should be accomplished (23).…”

“…The most common tests used by rehabilitation specialists for the PE of the shoulder such as Neer, Hawkins-Kennedy, Yocum, Jobe, Patte, Gerber, Yergasson, and palm-up as well as Popeye sign were presented in the current review study. 6 Middle East J Rehabil Health Stud. 2019; 6(1):e84347.…”

“…There are specific maneuvers that might identify tear location and extension in painful shoulders. There are up to 184 maneuvers on the literature to diagnose SP (6); however, certain maneuvers were more accurate than the others (4). Nevertheless, up to 35% of patients are unable to fulfill clinical tests due to painful conditions, showing limited range of motion.…”

“…There is consensus among specialists about the accuracy and sensitivity to diagnose shoulder pathology (13,14). Out of 184 known maneuvers to evaluate the shoulder, 10 are the most commonly used ones by specialists (6,13). The Neer, Hawkins, and Yocum tests are used to diagnose SIS.…”