Original articleReliability and Diagnostic Accuracy of 5 Physical Examination Tests and Combination of Tests for Subacromial Impingement
Section snippets
Methods
This was a prospective blinded cohort study approved by the Medical Center Investigational Review Board. Consecutive patients presenting with shoulder pain to an orthopedic surgeon's office were invited to participate in this study. To be included in this study, patients had to report shoulder pain for at least 1 week, and shoulder pain had to be their primary complaint. A total of 65 patients were invited to participate; 3 refused to participate, and 7 did not undergo the reference standard
Results
The reference standard surgical findings are summarized in table 1. The prevalence of SAIS was 29%; 16 of 55 patients were confirmed via the gold standard of surgical findings with SAIS either in isolation as the primary diagnosis or in combination with another glenohumeral joint diagnosis. The 39 subjects who did not have a confirmed diagnosis of SAIS were diagnosed via surgical findings with (in order of frequency) glenohumeral instability, glenoid labral tear, rotator cuff tear,
Discussion
To effectively treat patients with shoulder pain, they must first be accurately diagnosed. The physical examination tests used to diagnose shoulder patients should be reliable and accurate. This study has provided clinically useful information to diagnose SAIS. The interrater reliability was fair to substantial for the 5 tests. The painful arc, empty can, and external rotation resistance test individually and the test combination of any 3 positive tests out of 5 have the best ability to confirm
Conclusions
The results of this study provide new and expanded evidence as to the ability of 5 commonly used clinical tests. The single tests of painful arc, external rotation resistance test, and empty can provide the best diagnostic utility and reliability. The Neer test has clinical utility to screen for SAIS but has only fair reliability. Also of diagnostic utility is the use of the cut point of 3+/5 tests, with 3 or more tests positive of 5 useful in confirming SAIS, whereas less than 3 positive of
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