ABSTRACT
PURPOSE: Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears. METHODS: The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor. RESULTS: The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins-Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67-0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01-0.98), for the drop arm sign. CONCLUSIONS: The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times. LEVEL OF EVIDENCE: Level II.
Subject(s)
Rotator Cuff Injuries/diagnosis , Arthrography , Athletic Injuries/diagnosis , Athletic Injuries/diagnostic imaging , Humans , Magnetic Resonance Imaging , Physical Examination , Rotation , Rotator Cuff/diagnostic imaging , Rotator Cuff Injuries/diagnostic imaging , Sensitivity and SpecificityABSTRACT
BACKGROUND: Previous systematic reviews and meta-analyses on the diagnostic accuracy of shoulder clinical tests do not reach conclusions regarding subscapularis tears. PURPOSE: To compare the diagnostic accuracy of commonly used clinical tests for subscapularis tears. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: An electronic literature search was conducted using Medline, Embase, and the Cochrane Library/Central. Eligibility criteria were original clinical studies reporting the diagnostic accuracy of clinical tests to diagnose the presence of rotator cuff tears involving the subscapularis. RESULTS: The electronic literature search returned 2212 records, of which 13 articles were eligible. Among 8 tests included in the systematic review, the lift-off test was most frequently reported (12 studies). Four tests were eligible for meta-analysis: bear-hug test, belly-press test, internal rotation lag sign (IRLS), and lift-off test. The highest pooled sensitivity was 0.55 (95% CI, 0.28-0.79) for the bear-hug test, while the lowest pooled sensitivity was 0.32 (95% CI, 0.13-0.61), for the IRLS. In all tests, pooled specificity was >0.90. CONCLUSION: Among the 4 clinical tests eligible for meta-analysis (bear-hug test, belly-press test, IRLS, and lift-off test), all had pooled specificity >0.90 but pooled sensitivity <0.60. No single clinical test is sufficiently reliable to diagnose subscapularis tears. REGISTRATION: PROSPERO (CRD42019137019).
ABSTRACT
Neuropathic arthropathy is a pathology involving both upper and lower limbs. Different neurological diseases can cause this arthropathy. For instance, shoulder Charcot arthropathies are mostly associated to syringomyelia. The initial diagnosis of this arthropathy is difficult and often delayed in the presence of usually non specific symptoms. Since articular destruction is present in this disease, early diagnosis and primary management of the neurological condition is important, as it slows down the destruction of the joint.
L'arthropathie neuropathique est une pathologie touchant les membres supérieurs et inférieurs en lien avec différentes affections neurologiques. Dans le cadre de l'épaule, la syringomyélie est la cause la plus fréquente. La symptomatologie initiale est peu spécifique, peu douloureuse et conduit à la destruction articulaire. Le diagnostic est par conséquent difficile et souvent retardé. Une prise en charge optimale est nécessaire afin de traiter la pathologie neurologique sous-jacente, ce qui permet de ralentir la destruction articulaire.
