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Supraspinatus tears -- predictability of MRI findings based on clinical examination

Yazigi Junior J, Anauate Nicolao F, Matsunaga F, Archetti Netto N, Belloti J, Sugawara Tamaoki M

Journal of Shoulder and Elbow Surgery 2021 Aug;30(8):1834-1843

primary study

BACKGROUND: The shoulder physical examination is frequently performed to diagnose rotator cuff tears in clinical practice; however, there is insufficient evidence upon which physical tests are efficient for shoulder impingements in primary care. The purposes of this study were: (1) to analyze the accuracy of eight clinical tests to diagnose supraspinatus tendon lesions and to investigate whether the combination of these tests can improve the diagnostic values; (2) to assess which is the best positivity criteria for shoulder maneuvers: pain and/or weakness; (3) to investigate the ability of these tests to distinguish between partial and full-thickness tears. METHODS: A total of 733 consecutive patients were prospectively evaluated by four shoulder surgeons in this multicenter diagnostic study from May 2017 to December 2018, and eight clinical tests (Empty Can, Full Can, Drop Arm, Painful Arc, Neer's Sign, Hawkins', Patte's Test and resisted external rotation) were compared with magnetic resonance imaging performed by blinded radiologists. We assessed the sensitivity, specificity, accuracy, positive and negative predictive values, and diagnostic odds ratio (DOR) for all tests. RESULTS: For overall supraspinatus tears, the Empty Can Test showed the highest sensitivity (0.81), the Patte's Test (positive for pain and weakness) and the Drop Arm, the highest specificity (0.99 and 0.98, respectively), and the best combination was the Neer's Sign and the Drop Arm Test (DOR 12.92). The positivity criteria for pain associated with weakness showed the highest performance: Patte's (DOR 16.94) and empty can test (DOR = 10.45). Patte's Test and resisted external rotation, positive for pain and weakness, showed the highest ability to distinguish between full-thickness and partial tears (DOR 5.69 and 5.35, respectively). The shoulder maneuvers showed low negative predictive values: the Empty Can the highest (0.58). CONCLUSIONS: (1) The clinical tests demonstrated excellent diagnostic values, the empty can had the highest sensitivity, the Drop Arm and the Patte's Test the highest specificity; and the best combination for detecting supraspinatus tears was the Neer's Sign and the Drop Arm Test. On the other hand, the physical examination showed limited values to rule out tears. (2) The best positivity criteria for shoulder maneuvers was pain associated with weakness. (3) Patte's Test and resisted external rotation showed the highest ability to distinguish between full-thickness and partial tears.

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