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The Internal Rotation and Shift-Test for the detection of superior lesions of the rotator cuff: reliability and clinical performance

Fieseler G, Laudner K, Sendler J, Cornelius J, Schulze S, Lehmann W, Hermassi S, Delank K-S, Schwesig R

JSES International 2022 May;6(3):495-499

primary study

BACKGROUND: Using reliable and valid clinical tests are essential for proper diagnosis and clinical outcomes among injuries involving the rotator cuff. The addition of a new clinical examination test could improve the clinical diagnosis and informative value of the sensitivity and specificity of pathology. This study of diagnostic accuracy evaluated the use of a new rotator cuff test, called the Internal Rotation and Shift-Test (IRO/Shift-Test), to determine its reliability and clinical performance (sensitivity, specificity, positive (PPV)/negative predictive value (NPV)). Clinical diagnostic outcomes were confirmed with radiological findings (MRI). METHODS: 100 patients from a specialized shoulder unit participated (64 male, 36 female, mean age 55 +/- 13.5 years). A single-blinded (no knowledge of prior clinical or technical diagnostics) study design was used with two experienced physicians performing the IRO/Shift-Test. For clinical performance, all clinical testing was compared with MRI. RESULTS: The intra-rater (ICC 0.73, 95% CI 60 to 82) and inter-rater (ICC 0.89, 95% CI 81 to 94) coefficients for the IRO/Shift-Test showed good-to-excellent reliability. 75% of the patients showed a positive IRO/Shift-Test, while 65% had a radiologically diagnosed superior rotator cuff tear. 60% of these patients had both a positive IRO/Shift-Test and objective rotator cuff tear via MRI. The sensitivity of the IRO/Shift-Test to detect superior rotator cuff lesions based on MRI diagnosis was calculated at 92% (95% CI 86 to 99%), while specificity was 67% (95% CI 50 to 84%). Predictive values were also found to be high with 86% PPV (95% CI 78 to 94%) and 80% NPV (95% CI 64 to 96%). CONCLUSION: Our results demonstrate that the IRO/Shift-Test is a reliable and valid tool for assessing superior rotator cuff pathology. With good-to-excellent intrarater and inter-rater reliability and strong sensitivity and specificity this test should be considered a valuable addition to clinicians' cadre of clinical evaluation tools.

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