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May 4, 2022
Author: Eric
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  • Does This Patient With Shoulder Pain Have Rotator Cuff Disease?

You can find the original article here: http://jama.jamanetwork.com/article.aspx?articleid=1733724#tab5

Importance  Rotator cuff disease (RCD) is the most common cause of shoulder pain seen by physicians.

Objective  To perform a meta-analysis to identify the most accurate clinical examination findings for RCD.

Data Sources  Structured search in MEDLINE, EMBASE, and CINAHL from their inception through May 2013.

Study Selection  For inclusion, a study must have met the following criteria: (1) description of history taking, physical examination, or clinical tests concerning RCD; (2) detailing of sensitivity and specificity; (3) use of a reference standard with diagnostic criteria prespecified; (4) presentation of original data, or original data could be obtained from the authors; and (5) publication in a language mastered by one of the authors (Danish, Dutch, English, French, German, Norwegian, Spanish, Swedish).

Main Outcomes and Measures  Likelihood ratios (LRs) of symptoms and signs of RCD or of a tear, compared with an acceptable reference standard; quality scores assigned using the Rational Clinical Examination score and bias evaluated with the Quality Assessment of Diagnostic Accuracy Studies tool.

Results  Twenty-eight studies assessed the examination of referred patients by specialists. Only 5 studies reached Rational Clinical Examination quality scores of level 1-2.The studies with quality scores of level 1-2 included 30 to 203 shoulders with the prevalence of RCD ranging from 33% to 81%. Among pain provocation tests, a positive painful arc test result was the only finding with a positive LR greater than 2.0 for RCD (3.7 [95% CI, 1.9-7.0]), and a normal painful arc test result had the lowest negative LR (0.36 [95% CI, 0.23-0.54]). Among strength tests, a positive external rotation lag test (LR, 7.2 [95% CI, 1.7-31]) and internal rotation lag test (LR, 5.6 [95% CI, 2.6-12]) were the most accurate findings for full-thickness tears. A positive drop arm test result (LR, 3.3 [95% CI, 1.0-11]) might help identify patients with RCD. A normal internal rotation lag test result was most accurate for identifying patients without a full-thickness tear (LR, 0.04 [95% CI, 0.0-0.58]).

Conclusions and Relevance  Because specialists performed all the clinical maneuvers for RCD in each of the included studies with no finding evaluated in more than 3 studies, the generalizability of the results to a nonreferred population is unknown. A positive painful arc test result and a positive external rotation resistance test result were the most accurate findings for detecting RCD, whereas the presence of a positive lag test (external or internal rotation) result was most accurate for diagnosis of a full-thickness rotator cuff tear.

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About the Author Eric

Eric is a marketing technician at RangeMaster and also a shoulder surgery warrior. A severe accident resulted in multiple surgeries and Eric’s recovery was aided in no small part to RangeMaster products. It was because of their amazing product that he could live independent from painkillers and do all the things he loved before the accident (which includes boxing). He lives in Washington with his wife and children, who are the light of his life.

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