The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear

Journal of Orthopaedic Surgery and Research

W Jaap Willems⁴  Caroline B Terwee²  Vanessa AB Scholtes³  Rene M Castelein¹  Henk Jan van der Woude³  Tobias van den Berg²  Derk A van Kampen⁵ 

[1] Department of Orthopaedic Surgery and Traumatology, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands;Department of Epidemiology and Biostatistics and the EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands;Department of Orthopaedic Surgery and Traumatology, OLVG Hospital, Amsterdam 1091 AC, The Netherlands;Shoulder Unit, Lairesse Kliniek, Valeriusplein, Amsterdam 1075 BG, The Netherlands;Department of Orthopaedic Surgery and Traumatology, Waterland Hospital, Waterlandlaan 250, Purmerend 1441 RN, The Netherlands

关键词: Diagnoses;    Shoulder;    Specificity;    Sensitivity;    Physical examination;    Prediction model;    Diagnostic test;    Rotator cuff tears;   

Others  :  1152338
DOI  :  10.1186/s13018-014-0070-y

 received in 2014-04-24, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Background

It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear.

Methods

This prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N = 69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regression analysis.

Results and discussion

In this cohort, 38 patients were diagnosed with rotator cuff tears. The individual overall accuracy of the rotator cuff clinical tests was 61%–75%. After backward selection, the model determined that the most important predictors of rotator cuff tears were higher age and a positive Neer test. This internally validated prediction model had good discriminative ability (area under the receiver operating characteristic curve (AUC) = 0.73).

Conclusion

Our results showed that individual clinical shoulder tests had moderate diagnostic value for diagnosing rotator cuff tear. Our prediction model showed improved diagnostic value. However, the prediction value is still relatively low, supporting a low threshold for additional diagnostic tests for the diagnosis of rotator cuff tears.

Level of evidence

Study of diagnostic test: level I.

【 授权许可】

   
2014 Van Kampen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]McFarland EG, Garzon-Muvdi J, Jia X, Desai P, Petersen SA: Clinical and diagnostic tests for shoulder disorders: a critical review. Br J Sports Med 2010, 44:328-332.
• [2]van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Terwee CB, Willems WJ: Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability. J Shoulder Elbow Surg 2013, 22:1310-1319.
• [3]Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, Cook C: Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med 2008, 42:80-92.
• [4]Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA: Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med 2012, 46:964-978.
• [5]Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SMA: Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA 2013, 310:837-847.
• [6]Murrell GA, Walton JR: Diagnosis of rotator cuff tears. Lancet 2001, 357:769-770.
• [7]Park HB, Yokota A, Gill HS, Rassi El G, McFarland EG: Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005, 87:1446-1455.
• [8]Bhandari M, Montori VM, Swiontkowski MF, Guyatt GH: User's guide to the surgical literature: how to use an article about a diagnostic test. J Bone Joint Surg Am 2003, 85:1133-1140.
• [9]Schreinemachers SA, Hulst VPM, Willems WJ, Bipat S, Woude H-J: Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? Skeletal Radiol 2009, 38:967-975.
• [10]Slabaugh MA, Friel NA, Karas V, Romeo AA, Verma NN, Cole BJ: Interobserver and intraobserver reliability of the Goutallier classification using magnetic resonance imaging: proposal of a simplified classification system to increase reliability. Am J Sports Med 2012, 40:1728-1734.
• [11]Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR: A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med 1992, 21:384-390.
• [12]Lippitt SB, Matsen FA: A practical tool for evaluating function: the simple shoulder test. In The Shoulder: A Balance of Mobility and Stability.J Am Acad Orthop Surg 1993, 545–559.
• [13]Dawson J, Fitzpatrick R, Carr A: Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg (Br) 1996, 78:593-600.
• [14]Jobe FW, Jobe CM: Painful athletic injuries of the shoulder.Clin Orthop Relat Res 1983, 117–124.
• [15]Neer CS: Impingement lesions. Clin Orthop Relat Res 1983, 173:70-77.
• [16]Hawkins RJ, Kennedy JC: Impingement syndrome in athletes. Am J Sports Med 1980, 8:151-158.
• [17]Codman EA: The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. G Miller & Co Medical Publishers, Brooklyn, New York; 1934.
• [18]Gerber C, Krushell RJ: Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg (Br) 1991, 73:389-394.
• [19]Kessel L, Watson M: The painful arc syndrome. Clinical classification as a guide to management. J Bone Joint Surg (Br) 1977, 59:166-172.
• [20]Hertel R, Ballmer FT, Lombert SM, Gerber C: Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 1996, 5:307-313.
• [21]De Jesus JO, Parker L, Frangos AJ, Nazarian LN: Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. Am J Roentgenol 2009, 192:1701-1707.
• [22]Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F: Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013, 9:CD009020.
• [23]Resnick D: Diagnosis of Bone and Joint Disorders. 4eth edition. W B Saunders; 2002.
• [24]van Kampen DA, van Beers LWAH, Scholtes VAB, Terwee CB, Willems WJ: Validation of the Dutch version of the Simple Shoulder Test. J Shoulder Elbow Surg 2012, 21:808-814.
• [25]Berendes T, Pilot P, Willems WJ, Verburg H, Slaa te R: Validation of the Dutch version of the Oxford Shoulder Score. J Shoulder Elbow Surg 2010, 19:829-836.
• [26]Ambler G, Brady AR, Royston P: Simplifying a prognostic model: a simulation study based on clinical data. Stat Med 2002, 21:3803-3822.
• [27]Royston P, Moons KGM, Altman DG, Vergouwe Y: Prognosis and prognostic research: developing a prognostic model. BMJ 2009, 338:b604.
• [28]Harrell FE, Lee KL, Mark DB: Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996, 15:361-387.
• [29]David W, Hosmer J, Lemeshow S, Sturdivant RX: Applied Logistic Regression. 3eth edition. Wiley; 2013.
• [30]Austin PC, Tu JV: Bootstrap methods for developing predictive models. Am Stat 2004, 58:131-137.
• [31]Steyerberg EW, Eijkemans MJ, Habbema JD: Stepwise selection in small data sets: a simulation study of bias in logistic regression analysis. J Clin Epidemiol 1999, 52:935-942.
• [32]Bak K, Sørensen AKB, Jørgensen U, Nygaard M, Krarup AL, Thune C, Sloth C, Pedersen ST: The value of clinical tests in acute full-thickness tears of the supraspinatus tendon: does a subacromial lidocaine injection help in the clinical diagnosis? A prospective study. Arthroscopy 2010, 26:734-742.
• [33]Henkus H-E, Cobben LPJ, Coerkamp EG, Nelissen RGHH, van Arkel ERA: The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy 2006, 22:277-282.
• [34]Moons KGM, Royston P, Vergouwe Y, Grobbee DE, Altman DG: Prognosis and prognostic research: what, why, and how? BMJ 2009, 338:b375.
• [35]Vittinghoff E, McCulloch CE: Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007, 165:710-718.
• [36]Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJH: Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 2006, 88:116-121.
• [37]Johansson K, Ivarson S: Intra- and interexaminer reliability of four manual shoulder maneuvers used to identify subacromial pain. Man Ther 2009, 14:231-239.