Diagnostic accuracy in rotator cuff tears: clinical tests vs MRI
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192693Keywords:
Arthroscopy, Rotator cuff, ShoulderAbstract
Background: Till date there is a lack of consensus regarding validity of clinical tests in identifying the rotator cuff injuries and also the predictive value of noninvasive investigations done to confirm such shoulder pathology.
Methods: We included 48 patients with shoulder complaints in our study who underwent blinded clinical examination and MRI of shoulder, whose findings were compared with arthroscopic findings and were statistically analyzed.
Results: In the study group mean age was 47 years and 71% were males. When compared with arthroscopy, clinical examination for supraspinatus had better sensitivity (90) but low specificity and negative predictive value (NPV) (37.5). MRI evaluation of supraspinatus had specificity of 85 and NPV of 60. Infraspinatus had almost similar statistical values. MRI was found to have better specificity (89.5) in comparison with clinical examination (52.6) in subscapularis evaluation along with higher positive (67 vs. 30) and negative predictive value (94 vs. 90).
Conclusions: Clinical examination is good in identifying lesion or tear of supraspinatus and subscapularis but may also have false positives, where usage of noninvasive MRI will reduce these false positive in comparison with gold standard arthroscopy. Although clinical examination is very useful for diagnosis of rotator cuff injuries, MRI could be used to improve specificity and predictive values in patients who are planned for surgical management of rotator cuff injury.
References
Van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54:959–64.
Ostör AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology. 2005;44:800–5.
Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites and relation to social deprivation. Ann Rheum Dis. 1998;57:649–55.
Salaffi F, De Angelis R, Grassi W. Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. The MAPPING study. Clin Exp Rheumatol. 2005;23:819–28.
Vecchio P, Kavanagh RT, Hazleman BL, King RH. Community survey of shoulder disorders in the elderly to assess the natural history and effects of treatment. Ann Rheum Dis. 1995;54:152–4.
Badcock LJ, Lewis M, Hay EM, McCarney R, Croft PR. Chronic shoulder pain in the community: a syndrome of disability or distress? Ann Rheumatic Dis. 2002;61(2), 128–31.
Masters S, O’Doherty L, Mitchell GK, Yelland M. Acute shoulder pain in primary care-an observational study. Aust Fam Physician. 2007;36(6):473-6.
Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003;7(29).
May S, Chance-Larsen K, Littlewood C, Lomas D, Saad M. Reliability of physical examination tests used in the assessment of patients with shoulder problems: a systematic review. Physiotherapy. 2010;96:179–90.
Schellingerhout JM, Verhagen AP, Thomas S, Koes BW. Lack of uniformity in diagnostic labeling of shoulder pain: time for a different approach. Man Ther. 2008;13:478–83.
Bryant L, Shnier R, Bryant C, Murrell GA. A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. J Shoulder Elbow Surg. 2002;11:219–24.
Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004;86:708–16.
Malhi AM, Khan R. Correlation between clinical diagnosis and arthroscopic findings of the shoulder. Postgrad Med J. 2005;81:657–9.
Magee DJ. Shoulder. In: Orthopedic physical assessment, 2nd edn. Saunders, Philadelphia. 1992: 90–142.
Green S, Buchbinder R, Glazier R, Forbes A. Systemic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment and efficacy. BMJ. 1998;316:354–60.
Blanchard TK, Mackenzie R, Bearcroft PW, Sinnatamby R, Gray A, Lomas DJ, et al. Magnetic resonance imaging of the shoulder: assessment of effectiveness. Clin Radiol. 1997;52:363–8.
Beaudreuil J, Nizard R, Thomas T, Peyre M, Liotard JP, Boileau P, et al. Contribution of clinical tests to the diagnosis of rotator cuff disease: a systematic literature review. Joint Bone Spine. 2009;76:15–9.
Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42:80–92.
Östör, AJK., Richards, CA., Tytherleigh-Strong G, Bearcroft PW, Prevost AT, Speed CA, et al. Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions. Clin Rheumatol. 2013;32(9):1283–91.
Fowler EM, Horsley IG, Rolf CG. Clinical and arthroscopic findings in recreationally active patients. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:2.
Reilly P, Macleod I, MacFarlane R, Windley J, Emery RJ. Dead men and radiologists don’t lie: a review of cadaveric and radiologists studies of rotator cuff tear prevalence. Ann R Coll Surg Engl. 2006;88:116–21.
Salaffi F, Ciapetti A, Carotti M, Gasparini S, Filippucci E, Grassi W. Clinical value of single versus composite provocative clinical tests in the assessment of painful shoulder. J Clin Rheumatol. 2010;16:105–8.
