The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study

Overview

Journal Am J Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2016 Jul 9

PMID 27386812

Citations 31

Authors

Nitin B Jain

Jennifer Luz

Laurence D Higgins

Yan Dong

Jon J P Warner

Elizabeth Matzkin

Jeffrey N Katz

Affiliations

Soon will be listed here.

Abstract

Objective: The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears.

Design: From February 2011 to December 2012, 208 participants with shoulder pain were recruited in a cohort study.

Results: Among tests for supraspinatus tears, Jobe test had a sensitivity of 88% (95% confidence interval [CI], 80%-96%), specificity of 62% (95% CI, 53%-71%), and likelihood ratio of 2.30 (95% CI, 1.79-2.95). The full can test had a sensitivity of 70% (95% CI, 59%-82%) and a specificity of 81% (95% CI, 74%-88%). Among tests for infraspinatus tears, external rotation lag signs at 0 degrees had a specificity of 98% (95% CI, 96%-100%) and a likelihood ratio of 6.06 (95% CI, 1.30-28.33), and the Hornblower sign had a specificity of 96% (95% CI, 93%-100%) and likelihood ratio of 4.81 (95% CI, 1.60-14.49).

Conclusions: Jobe test and full can test had high sensitivity and specificity for supraspinatus tears, and Hornblower 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.

Citing Articles

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References

Kim E, Jeong H, Lee K, Song J . Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff. Acta Med Okayama. 2006; 60(4):223-8. DOI: 10.18926/AMO/30715. View

Salaffi F, Ciapetti A, Carotti M, Gasparini S, Filippucci E, Grassi W . Clinical value of single versus composite provocative clinical tests in the assessment of painful shoulder. J Clin Rheumatol. 2010; 16(3):105-8. DOI: 10.1097/RHU.0b013e3181cf8392. View

Michener L, Walsworth M, Doukas W, Murphy K . Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009; 90(11):1898-903. DOI: 10.1016/j.apmr.2009.05.015. View

Ben Kibler W, Sciascia A, Hester P, Dome D, Jacobs C . Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009; 37(9):1840-7. DOI: 10.1177/0363546509332505. View

Jia X, Petersen S, Khosravi A, Almareddi V, Pannirselvam V, McFarland E . Examination of the shoulder: the past, the present, and the future. J Bone Joint Surg Am. 2009; 91 Suppl 6:10-8. DOI: 10.2106/JBJS.I.00534. View

Sher J, Uribe J, Posada A, Murphy B, Zlatkin M . Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995; 77(1):10-5. DOI: 10.2106/00004623-199501000-00002. View

Hermans J, Luime J, Meuffels D, Reijman M, Simel D, Bierma-Zeinstra S . Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA. 2013; 310(8):837-47. DOI: 10.1001/jama.2013.276187. View

Simel D, Feussner J, DeLong E, Matchar D . Intermediate, indeterminate, and uninterpretable diagnostic test results. Med Decis Making. 1987; 7(2):107-14. DOI: 10.1177/0272989X8700700208. View

Hijioka A, Suzuki K, Nakamura T, Hojo T . Degenerative change and rotator cuff tears. An anatomical study in 160 shoulders of 80 cadavers. Arch Orthop Trauma Surg. 1993; 112(2):61-4. DOI: 10.1007/BF00420255. View

10.

Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M . Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995; 77(2):296-8. View

11.

Yamaguchi K, Tetro A, Blam O, Evanoff B, Teefey S, Middleton W . Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001; 10(3):199-203. DOI: 10.1067/mse.2001.113086. View

12.

Greenhalgh T . How to read a paper. Papers that report diagnostic or screening tests. BMJ. 1997; 315(7107):540-3. PMC: 2127365. DOI: 10.1136/bmj.315.7107.540. View

13.

Tennent T, Beach W, Meyers J . A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests. Am J Sports Med. 2003; 31(1):154-60. DOI: 10.1177/03635465030310011101. View

14.

Stevenson J, Trojian T . Evaluation of shoulder pain. J Fam Pract. 2002; 51(7):605-11. View

15.

Faruqui S, Wijdicks C, Foad A . Sensitivity of physical examination versus arthroscopy in diagnosing subscapularis tendon injury. Orthopedics. 2014; 37(1):e29-33. DOI: 10.3928/01477447-20131219-13. View

16.

Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Banos J . Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis. 2002; 61(2):132-6. PMC: 1754006. DOI: 10.1136/ard.61.2.132. View

17.

Chen H, Lin S, Hsu Y, Chen S, Kang J . A comparison of physical examinations with musculoskeletal ultrasound in the diagnosis of biceps long head tendinitis. Ultrasound Med Biol. 2011; 37(9):1392-8. DOI: 10.1016/j.ultrasmedbio.2011.05.842. View

18.

Kim H, Kim S, Seo Y . Ultrasonographic findings of painful shoulders and correlation between physical examination and ultrasonographic rotator cuff tear. Mod Rheumatol. 2007; 17(3):213-9. DOI: 10.1007/s10165-007-0577-8. View

19.

Shinkins B, Thompson M, Mallett S, Perera R . Diagnostic accuracy studies: how to report and analyse inconclusive test results. BMJ. 2013; 346:f2778. DOI: 10.1136/bmj.f2778. View

20.

Yuen C, Mok K, Kan P . The validity of 9 physical tests for full-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients. Am J Emerg Med. 2012; 30(8):1522-9. DOI: 10.1016/j.ajem.2011.12.022. View