Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement

Hanchard, Nigel; Lenza, Mário; Handoll, Helen; Takwoingi, Yemisi

doi:10.1002/14651858.cd007427.pub2

Cited by 93 publications

(67 citation statements)

References 254 publications

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“…Special tests are extensively described in the literature 6–8 but data on diagnostic accuracy of special tests is sparse and inconclusive, thereby leading to heavy reliance on expensive shoulder imaging to aid in the diagnosis 8–10 . Prior studies have provided data on individual or only few of the special tests described for the rotator cuff 26,27,30–35 .…”

Section: Discussionmentioning

confidence: 99%

“…However, data on the sensitivity and specificity of special tests are sparse and conflicting, providing little guidance to the clinician in the diagnosis of this common musculoskeletal disorder. This issue is highlighted in several recent expert reviews 8–10 . Thus, there is need for studies assessing diagnostic accuracy of special tests for rotator cuff tears to guide the clinician during their physical examination.…”

Section: Introductionmentioning

confidence: 99%

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The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear

Jain

Luz

Higgins

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears. Design From 02/2011 to 12/2012, 208 participants with shoulder pain were recruited in a cohort study. Results Among tests for supraspinatus tears, Jobe’s test had a sensitivity of 88% (95% CI=80% to 96%), specificity of 62% (95% CI=53% to 71%), and likelihood ratio of 2.30 (95% CI=1.79 to 2.95). The full can test had a sensitivity of 70% (95% CI=59% to 82%) and a specificity of 81% (95% CI=74% to 88%). Among tests for infraspinatus tears, external rotation lag signs at 0° had a specificity of 98% (95% CI=96% to 100%) and a likelihood ratio of 6.06 (95% CI=1.30 to 28.33), and the Hornblower’s sign had a specificity of 96% (95% CI=93% to 100%) and likelihood ratio of 4.81 (95% CI=1.60 to 14.49). Conclusions Jobe’s test and full can test had high sensitivity and specificity for supraspinatus tears and Hornblower’s sign performed well for infraspinatus tears. In general, special tests described for subscapularis tears have high specificity but low sensitivity. These data can be used in clinical practice to diagnose rotator cuff tears and may reduce the reliance on expensive imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear

Jain

Luz

Higgins

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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“…[29] Although some individual studies have reported sensitivity and specificity properties for these maneuvers that may seem reasonable, other studies have arrived at different results, and a recent Cochrane review has not found sufficient evidence to recommend any examination element, likely due to “extreme diversity” in techniques compared to the original descriptions. [30] Many studies have not examined combinations of individual elements into a systematic, synthetic approach; some even question the relevance and role of the physical examination altogether, in contrast with the summary recommendation of the US Bone and Joint Initiative. [31, 32] No group has yet proposed a detailed checklist of elements for the physical exam of the shoulder for use in a multidisciplinary educational program.…”

Section: Discussionmentioning

confidence: 99%

Validity evidence for two objective structured clinical examination stations to evaluate core skills of the shoulder and knee assessment

et al. 2017

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BackgroundWe developed two objective structured clinical examinations (OSCEs) to educate and evaluate trainees in the evaluation and management of shoulder and knee pain. Our objective was to examine the evidence for validity of these OSCEs.MethodsA multidisciplinary team of content experts developed checklists of exam maneuvers and criteria to guide rater observations. Content was proposed by faculty, supplemented by literature review, and finalized using a Delphi process. One faculty simulated the patient, another rated examinee performance. Two faculty independently rated a portion of cases. Percent agreement was calculated and Cohen’s kappa corrected for chance agreement on binary outcomes. Examinees’ self-assessment was explored by written surveys. Responses were stratified into 3 categories and compared with similarly stratified OSCE scores using Pearson’s coefficient.ResultsA multi-disciplinary cohort of 69 examinees participated. Examinees correctly identified rotator cuff and meniscal disease 88% and 89% of the time, respectively. Inter-rater agreement was moderate for the knee (87%; k = 0.61) and near perfect for the shoulder (97%; k = 0.88). No correlation between stratified self-assessment and OSCE scores were found for either shoulder (0.02) or knee (−0.07).ConclusionsValidity evidence supports the continuing use of these OSCEs in educational programs addressing the evaluation and management of shoulder and knee pain. Evidence for validity includes the systematic development of content, rigorous control of the response process, and demonstration of acceptable interrater agreement. Lack of correlation with self-assessment suggests that these OSCEs measure a construct different from learners’ self-confidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0850-7) contains supplementary material, which is available to authorized users.

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“…68 This procedure was adopted from a published diagnostic test accuracy protocol from the Cochrane Library in the context of physical examination of the shoulder. 27 We performed our electronic literature search in 3 databases (MED-LINE, Embase, Allied and Complementary Medicine Database), consistent with recommendations to search in more than just 1 database for diagnostic test accuracy studies. 16,89 We decided not to search within PEDro, in contrast to authors of other diagnostic test accuracy reviews, 13,78 because this database contains few diagnostic studies.…”

Section: Discussionmentioning

confidence: 99%