Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests

Abstract

Objective: To compile and critique research on the diagnostic accuracy of individual orthopaedic physical examination tests in a manner that would allow clinicians to judge whether these tests are valuable to their practice. Methods: A computer-assisted literature search of MEDLINE, CINAHL, and SPORTDiscus databases (1966( to October 2006 using keywords related to diagnostic accuracy of physical examination tests of the shoulder. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to critique the quality of each paper. Meta-analysis through meta-regression of the diagnostic odds ratio (DOR) was performed on the Neer test for impingement, the Hawkins2Kennedy test for impingement, and the Speed test for superior labral pathology. Results: Forty-five studies were critiqued with only half demonstrating acceptable high quality and only two having adequate sample size. For impingement, the metaanalysis revealed that the pooled sensitivity and specificity for the Neer test was 79% and 53%, respectively, and for the Hawkins2Kennedy test was 79% and 59%, respectively. For superior labral (SLAP) tears, the summary sensitivity and specificity of the Speed test was 32% and 61%, respectively. Regarding orthopaedic special tests (OSTs) where meta-analysis was not possible either due to lack of sufficient studies or heterogeneity between studies, the list that demonstrates both high sensitivity and high specificity is short: hornblowers's sign and the external rotation lag sign for tears of the rotator cuff, biceps load II for superior labral anterior to posterior (SLAP) lesions, and apprehension, relocation and anterior release for anterior instability. Even these tests have been under-studied or are from lower quality studies or both. No tests for impingement or acromioclavicular (AC) joint pathology demonstrated significant diagnostic accuracy. Conclusion: Based on pooled data, the diagnostic accuracy of the Neer test for impingement, the Hawkins2Kennedy test for impingement and the Speed test for labral pathology is limited. There is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the numerous physical examination tests of the shoulder. Currently, almost without exception, there is a lack of clarity with regard to whether common OSTs used in clinical examination are useful in differentially diagnosing pathologies of the shoulder.History and physical examination of patients with shoulder pain has traditionally been a cornerstone of the diagnostic process. Diagnosis based on physical findings is important to determine a treatment path and because the ability to correctly diagnose the source of shoulder pain can save the patient from further diagnostic tests that are more costly, painful or inconvenient. Physical examination tests or orthopaedic special tests (OSTs) have historically been an integral part of this process. However, despite the fact that studies on the diagnostic accuracy of OSTs in the shoulder have been published at an acce...

Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders

“…The value of such clinical tests has been questioned (Hegedus et al 2008(Hegedus et al , 2012Lewis 2009) since structural pathology has been identified in the shoulder region of many asymptomatic people (Frost et al 1999;Girish et al 2011). Thus, on assessment it is difficult to determine whether the patients' symptoms are due to the observed structural failure (Lewis 2009(Lewis , 2011.…”

“…Several clinical tests have been described to identify lesions in specific tissues, such as the rotator cuff or the subacromial bursa; however, there is little evidence to support their diagnostic value (Hegedus et al 2008(Hegedus et al , 2012. The value of such clinical tests has been questioned (Hegedus et al 2008(Hegedus et al , 2012Lewis 2009) since structural pathology has been identified in the shoulder region of many asymptomatic people (Frost et al 1999;Girish et al 2011).…”

A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement

“…Previous clinical trials investigated the effects and outcomes of thoracic SMT in patients with shoulder pain, specifically high-velocity, low-amplitude thrusts applied at the end of the joint motion. 6,7,27 In our study, the patients received repetitive lateral translation from both sides at the beginning of the treatment (Fig 1). After this technique, the patients received 5 manipulation techniques on the thoracic spine 1 : technique lift with impulse, high velocity, and low amplitude applied to the midthoracic area, consisting of a manipulation of axial distraction with fulcrum on the thoracic area (Fig 2) 2 ; dog technique manipulation in flexion applied to (a) the upper thoracic spine (T1-T4) (Fig 3), (b) the midthoracic spine (T5-T8) (Fig 4), and (c) the low thoracic spine (T9-T12) ( 3 ; manipulation with impulse applied to the midthoracic area: therapist contacted the transverse process for manipulation with the thumb facing inferior and the contralateral thumb directed toward the head.…”

“…26 The pooled sensitivity and specificity for the Neer test is 79% and 53%, respectively, and for the Hawkins-Kennedy test is 79% and 59%, respectively. 27 The shoulder active range of motion of flexion, extension, rotation (internal and external), adduction and abduction were measured using a digital goniometer (NORAXON Desktop DTS; Noraxon, Scottsdale, AZ).…”

An Extensive Evaluation of Different Knee Stability Assessment Measures: A Systematic Review

“…Any possible disagreement was planned to be resolved during a scheduled meeting. Based on similar published reviews, any study with a QUADAS score ě10 was stratified as "high quality/low risk of bias", and any study scoring <10 was considered "low quality/high risk of bias" [18].…”