How Effective are Diagnostic Tests for the Assessment of Rotator Cuff Disease of the Shoulder?

Lewis, Jeremy; Tennent, Duncan

doi:10.1002/9780470988732.ch18

Cited by 21 publications

(24 citation statements)

References 113 publications

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“…Any test designed to assess the integrity and pain response from any of the rotator cuff tendons would involve bursal tissue. Two comprehensive systematic reviews of the diagnostic accuracy of the rotator cuff tests have been conducted1 4 and have reached similar conclusions. Both reviews reported that, although a myriad of clinical tests have been proposed to selectively assess the rotator cuff and subacromial bursal tissues and the integrity of the subacromial space, no test or series of tests have emerged that are capable of doing this.…”

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 72%

“…However, it is unlikely that any test would not stretch or compress adjacent structures or cause them to contract during the procedure. Without doubt this is one of the reasons why more recent studies on the sensitivity, specificity and predictive accuracy of tests1 – 4 have concluded that, although they have a high sensitivity and reproduce symptoms, they have an associated low specificity which substantially reduces their utility in deriving a specific diagnosis. As such the commonly used orthopaedic special tests should be thought of as pain or symptom provocation tests, without the ability to contribute to a structural diagnosis.…”

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 99%

“…The clinical implications of the confluence of tendon, ligament (coracohumeral) and glenohumeral capsule are profound and clinical tests proposed to identify symptoms arising from any one individual tendon12 13 are groundless. The lack of specificity of the clinical tests for the rotator cuff has been demonstrated1 4 14 and clinical reasoning based on the response of these tests needs to be re-evaluated. In addition to the fusing of the rotator cuff tendons, the large SAB is innervated15 16 and appears to have a central role in the presentation of pain in the shoulder 15 – 20.…”

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 99%

“…Difficulties in deriving a definitive structural diagnosis of symptomatic shoulder tissues have been recognised by others 1 3 4 14 31 – 33. In response to these difficulties, alternative methods of assessment have been suggested 34 35.…”

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 99%

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Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?

Lewis¹

2008

Br J Sports Med

265

174

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Disorders of the shoulder are extremely common, with reports of prevalence ranging from 30% of people experiencing shoulder pain at some stage of their lives up to 50% of the population experiencing at least one episode of shoulder pain annually. In addition to the high incidence, shoulder dysfunction is often persistent and recurrent, with 54% of sufferers reporting ongoing symptoms after 3 years. To a large extent the substantial morbidity reflects (i) a current lack of understanding of the pathoaetiology, (ii) a lack of diagnostic accuracy in the assessment process, and (iii) inadequacies in current intervention techniques. Pathology of the rotator cuff and subacromial bursa is considered to be the principal cause of pain and symptoms arising from the shoulder. Generally these diagnostic labels relate more to a clinical hypothesis as to the underlying cause of the symptoms than to definitive evidence of the histological basis for the diagnosis or the correlation between structural failure and symptoms. Diagnosing rotator cuff tendinopathy or subacromial impingement syndrome currently involves performing a structured assessment that includes taking the patient's history in conjunction with performing clinical assessment procedures that generally involve tests used to implicate an isolated structure. Based on the response to the clinical tests, a diagnosis of rotator cuff tendinopathy or subacromial impingement syndrome is achieved. The clinical diagnosis is strengthened with the findings from supporting investigations such as blood tests, radiographs, ultrasound, magnetic resonance imaging (MRI), computed axial tomography (CT), radionucleotide isotope scan, single photon emission computed tomography, electromyography, nerve conduction and diagnostic analgesic injection. This process eventually results in the formation of a clinical hypothesis, and then, in conjunction with the patient, a management plan is decided upon and implemented. This paper focuses on the dilemmas associated with the current process, and an alternative method for the clinical examination of the shoulder for this group of patients is proposed.Pathology of the rotator cuff and subacromial bursa is considered to be the principal cause of pain and symptoms arising from the shoulder. This is reflected in the variety of diagnostic labels given to describe the pathology: rotator cuff tendinopathy/ tendinosis/tendinitis, supraspinatus tendinopathy/ tendinosis/tendinitis, subacromial impingement syndrome, subacromial bursitis, bursal reaction, partial thickness, full thickness and massive rotator cuff tear. Generally these diagnostic labels relate to a clinical hypothesis attempting to explain the cause of presenting symptoms rather than to a definitive diagnosis based on robust and definitive biomechanical, histological and imaging evidence to explain the basis of the presenting symptoms.The substantial morbidity associated with rotator cuff pathology reflects (i) a current lack of understanding of the pathoaetiology, (ii) a lack of diag...

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Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 72%

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 99%

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 99%

Section: Assessment Of Rotator Cuff Pathologymentioning

confidence: 99%

See 2 more Smart Citations

Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?

Lewis¹

2008

Br J Sports Med

265

174

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“…Birçok özel klinik test, diğer omuz patolojilerinde de pozitif bulunabilmektedir ve bu testler spesifik bölgelerdeki patolojileri değerlendirirken subakromial-subdeltoid bursa gibi etraftaki diğer dokuları da etkilemektedir. Bu da düşük seçiciliği açıklayabilir (17,19,21,22).…”

Section: Discussionunclassified

Diagnostic Performance of Clinical Tests in Patients with Shoulder Pain

Şengül¹,

Karagöz²,

Nacır³

et al. 2014

Turk J Phys Med Rehab

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Objective: This study aimed to investigate the diagnostic performance of clinical tests applied to patients with shoulder pain at a physical therapy outpatient clinic. Magnetic resonance imaging (MRI) findings were the major determinants to evaluate the accuracy of the clinical tests. Also, the relationship between the MRI findings and the pain and functional status of the shoulder were evaluated. Material and Methods: Seventy-six patients, referred to a physical therapy outpatient clinic with shoulder pain, were included in the study. Physical examination of all patients and specific clinical tests were performed for different shoulder pathologies. Pain levels of patients were evaluated with the visual analog scale and functional status of the shoulder with the Shoulder Disability Questionnaire. All patients were evaluated with MRI. Sensitivity, specificity, and positive and negative predictive values of the clinical tests were evaluated on the basis of the MRI findings. Results: The sensitivity of the tests evaluating impingement and rotator cuff pathologies was found to be high, but specificity was low. Diagnostic performance of the drop arm test to determine the supraspinatus ruptures; Yocum test to determine the subacromial and subdeltoid effusion; Patte test and external rotation lag sign to determine infraspinatus tendon pathologies; speed test to determine biceps pathologies; and horizontal adduction test and painful arc test to determine acromioclavicular joint pathologies were found to be statistically significant. In this study, the severity of pain and shoulder pathologies showed no statistically significant correlation. In terms of functional status, high scores were achieved only in the bicipital tendinitis group. Conclusion: MRI findings show that patients with shoulder pain may have multiple pathological lesions. Despite the coexistence of multiple pathologies and low specificity of clinical tests, clinical tests evaluating shoulder pathologies have great importance in directing the clinicians to diagnose and plan treatments because of high sensitivity.

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Topical glyceryl trinitrate for rotator cuff disease

Cumpston

Johnston

Buchbinder

2009

Cochrane Database of Systematic Reviews

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There is some evidence from one study at high risk of bias that topical glyceryl trinitrate is more effective than placebo for rotator cuff disease among patients with acute symptoms (< seven-days duration), but there is insufficient evidence to be certain about their longer-term effects. Headache was a common side effect in one trial and any benefits of treatment need to be balanced against the risk of headache. Further high quality research is needed to determine the effectiveness and safety of this new therapy.

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How Effective are Diagnostic Tests for the Assessment of Rotator Cuff Disease of the Shoulder?

Cited by 21 publications

References 113 publications

Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?

Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?

Diagnostic Performance of Clinical Tests in Patients with Shoulder Pain

Topical glyceryl trinitrate for rotator cuff disease

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