The Value of Clinical Tests in Acute Full-Thickness Tears of the Supraspinatus Tendon: Does a Subacromial Lidocaine Injection Help in the Clinical Diagnosis? A Prospective Study

Bak, Klaus; Sørensen, Anne Kathrine Belling; Jørgensen, U. G.; Nygaard, Marianne; Krarup, Annabel Lee; Thune, Charlotte; Sloth, Carsten; Pedersen, Søren Torp

doi:10.1016/j.arthro.2009.11.005

Cited by 59 publications

(29 citation statements)

References 32 publications

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“…Therefore, the rotator cuff tear group included those studies where diagnostic accuracy was examined inclusive of any size of tear or classification system used. Three studies25 30 33 in the RCT category addressed full-thickness tears, one study39 addressed massive RCTs, and six studies41 42 46 52–54 addressed RCT's regardless of size or classification. Of the 10 RCT studies, five used tests designed to test specific, individual muscles of the rotator cuff.…”

Section: Resultsmentioning

confidence: 99%

Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests

et al. 2012

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Objective To update our previously published systematic review and meta-analysis by subjecting the literature on shoulder physical examination (ShPE) to careful analysis in order to determine each tests clinical utility. Methods This review is an update of previous work, therefore the terms in the Medline and CINAHL search strategies remained the same with the exception that the search was confi ned to the dates November, 2006 through to February, 2012. The previous study dates were 1966 -October, 2006. Further, the original search was expanded, without date restrictions, to include two new databases: EMBASE and the Cochrane Library. The Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS 2) tool was used to critique the quality of each new paper. Where appropriate, data from the prior review and this review were combined to perform meta-analysis using the updated hierarchical summary receiver operating characteristic and bivariate models. Results Since the publication of the 2008 review, 32 additional studies were identifi ed and critiqued. For subacromial impingement, the meta-analysis revealed that the pooled sensitivity and specifi city for the Neer test was 72% and 60%, respectively, for the HawkinsKennedy test was 79% and 59%, respectively, and for the painful arc was 53% and 76%, respectively. Also from the meta-analysis, regarding superior labral anterior to posterior (SLAP) tears, the test with the best sensitivity (52%) was the relocation test; the test with the best specifi city (95%) was Yergason's test; and the test with the best positive likelihood ratio (2.81) was the compression-rotation test. Regarding new (to this series of reviews) ShPE tests, where meta-analysis was not possible because of lack of suffi cient studies or heterogeneity between studies, there are some individual tests that warrant further investigation. A highly specifi c test (specifi city >80%, LR+ ≥ 5.0) from a low bias study is the passive distraction test for a SLAP lesion. This test may rule in a SLAP lesion when positive. A sensitive test (sensitivity >80%, LR− ≤ 0.20) of note is the shoulder shrug sign, for stiffnessrelated disorders (osteoarthritis and adhesive capsulitis) as well as rotator cuff tendinopathy. There are six additional tests with higher sensitivities, specifi cities, or both but caution is urged since all of these tests have been studied only once and more than one ShPE test (ie, active compression, biceps load II) has been introduced with great diagnostic statistics only to have further research fail to replicate the results of the original authors. The belly-off and modifi ed belly press tests for subscapularis tendinopathy, bony apprehension test for bony instability, olecranon-manubrium percussion test for bony abnormality, passive compression for a SLAP lesion, and the lateral Jobe test for rotator cuff tear give reason for optimism since they demonstrated both high sensitivities and specifi cities reported in low bias studies. Finally, one additional test was studied in tw...

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Section: Resultsmentioning

confidence: 99%

Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests

et al. 2012

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“…Prior studies have provided data on individual or only few of the special tests described for the rotator cuff 26,27,30–35 . This issue was addressed in this study by assessing 15 tests commonly used for the diagnosis of rotator cuff tear and biceps pathology.…”

Section: Discussionmentioning

confidence: 99%

“…This issue was addressed in this study by assessing 15 tests commonly used for the diagnosis of rotator cuff tear and biceps pathology. Prior studies also had limitations such as recruitment from single sites/providers or data obtained by retrospective chart review 27,28,30,32–36 This study addressed these limitations by recruiting from multiple sites and providers, and recruiting patients prospectively. Prior studies have also used either imaging or surgical findings as reference standard for their case definition of a rotator cuff tear 26–28,30–36 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies also had limitations such as recruitment from single sites/providers or data obtained by retrospective chart review 27,28,30,32–36 This study addressed these limitations by recruiting from multiple sites and providers, and recruiting patients prospectively. Prior studies have also used either imaging or surgical findings as reference standard for their case definition of a rotator cuff tear 26–28,30–36 . Although MRI/MRA have high sensitivity and specificity for the diagnosis of rotator cuff tear 37–41 , it is well-documented that rotator cuff tears are present even in asymptomatic individuals 19–22 .…”

Section: Discussionmentioning

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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“…Park et al evaluated the diagnostic accuracy of clinical tests for full-thickness rotator cuff tears and found that the combination of a painful arc, drop arm sign, and infraspinatus muscle test produced the best probability for a full-thickness rotator cuff tear [5]. In a subsequent study, Bak et al supported the above finding and found that a positive lag sign (external rotation lag or drop arm test) is indicative of a full-thickness rotator cuff tear and specificity is further improved with a subacromial lidocaine injection [6]. However, in patients with severe shoulder arthritis and limitation of range of motion, using the above tests may be difficult to diagnose rotator cuff tears.…”

Section: History Presentation and Physical Examinationmentioning

confidence: 93%

Management of complications after total shoulder arthroplasty

Eichinger

Galvin

2015

Curr Rev Musculoskelet Med

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The outcomes of total shoulder arthroplasty (TSA) for painful arthritis of the glenohumeral joint are excellent with significant improvement in pain and function. Increased use of total shoulder arthroplasty over the past decade has led to identification of common complications. Although the complication rate is low, accurate and timely diagnosis, appropriate management, and implementation of methods for prevention are critical to a successful long-term outcome. The most common complications include infection, glenoid and humeral component loosening, rotator cuff tear, periprosthetic fracture, and neurologic injury. The purpose of this review is to outline the best practices for diagnosing, managing, and preventing these complications.

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The Value of Clinical Tests in Acute Full-Thickness Tears of the Supraspinatus Tendon: Does a Subacromial Lidocaine Injection Help in the Clinical Diagnosis? A Prospective Study

Cited by 59 publications

References 32 publications

Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests

Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests

The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear

Management of complications after total shoulder arthroplasty

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