Accuracy of physical examination against magnetic resonance imaging in subacromial impingement syndrome
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262033Keywords:
Subacromial impingement syndrome, Physical examination, MRI, Shoulder pain, Diagnostic accuracy, OrthopaedicsAbstract
Background: Subacromial impingement syndrome (SIS) is a leading cause of shoulder pain, accounting for nearly half of all shoulder complaints. Accurate diagnosis is essential, yet challenging due to anatomical complexity and overlapping symptoms. While physical examination (PE) remains crucial, magnetic resonance imaging (MRI) offers superior soft tissue assessment. This study aimed to evaluate the diagnostic accuracy of specific PE tests for SIS in comparison with MRI.
Methods: A cross-sectional study was conducted on 38 patients with shoulder pain presenting to the Department of Orthopaedics, Era’s Lucknow Medical College and Hospital, Lucknow, from May 2022 to May 2024. Patients underwent a series of PE manoeuvres including Passive abduction, Neer, Hawkins, Yocum, Jobe, Patte, Gerber, and Resisted abduction tests. MRI of the symptomatic shoulder was performed within five days of PE and interpreted by a blinded radiologist. Diagnostic performance of each PE test was evaluated using MRI as the reference standard.
Results: The mean participant age was 48.6 years; 63.16% were male. SIS was confirmed via MRI in 55.26% of participants. Among the PE tests, Passive abduction demonstrated the highest accuracy (68.42%), with sensitivity 72.00% and specificity 61.54%, and was the only test with statistically significant correlation to MRI (p=0.0448). Other tests such as Hawkins, Yocum, and Neer showed high sensitivity but lower specificity. The Patte test had the lowest diagnostic accuracy.
Conclusions: The Passive abduction test was the most reliable for diagnosing SIS. While some tests showed reasonable sensitivity, low specificity limited their overall accuracy. PE remains valuable but is best used in conjunction with MRI for optimal diagnosis.
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(12):959-64.
Koester MC, George MS, Kuhn JE. Shoulder impingement syndrome. Am J Med. 2005;118(5):452-5.
Bigliani LU, Levine WN. Current concepts review: subacromial impingement syndrome. J Bone Joint Surg Am. 1997;79(12):1854-68.
Neer CS. Impingement lesions. Clin Orthop Relat Res. 1983;173:70-6.
Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia). 2012;4(2):e18.
Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76.
Buchbinder R, Green S, Youd JM, Cochrane Musculoskeletal Group. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2010;(1):CD004016.
Louwerens JK, Sierevelt IN, Van Noort A, Van den Bekerom MP. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2014;23(8):1240-9.
Haik MN, Alburquerque-Sendín F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016;50(18):1124-34.
Ruotolo C, Nottage WM. Surgical and nonsurgical management of rotator cuff tears. Arthroscopy. 2002;18(5):527-31.
Baring T, Emery R, Reilly P. Management of rotator cuff disease: specific treatment for specific disorders. Best Pract Res Clin Rheumatol. 2007;21(2):279-94.
Nazari G, MacDermid JC, Bryant D, Athwal GS. The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome: a systematic review and meta-analysis. PLoS One. 2019;14(5):e0216961.
Birtane M, Çalış M, Akgün K. The diagnostic value of magnetic resonance imaging in subacromial impingement syndrome. Yonsei Med J. 2001;42(4):418-24.
McFarland EG, Selhi HS, Keyurapan E. Clinical evaluation of impingement: what to do and what works. J Bone Joint Surg Am. 2006;88(2):432-41.
Leroux JL, Thomas E, Bonnel F, Blotman F. Diagnostic value of clinical tests for shoulder impingement syndrome. Rev Rhum Engl Ed. 1995;62(6):423-8.
Silva L, Andreu JL, Muñoz P, Pastrana M, Millán I, Sanz J, Barbadillo C, et al. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford). 2008;47(5):679-83.
Sasiponganan C, Dessouky R, Ashikyan O, Pezeshk P, McCrum C, Xi Y, et al. Subacromial impingement anatomy and its association with rotator cuff pathology in women: radiograph and MRI correlation, a retrospective evaluation. Skeletal Radiol. 2019;48:781-90.
Aoyama JT, Maier P, Servaes S, Serai SD, Ganley TJ, Potter HG, et al. MR imaging of the shoulder in youth baseball players: anatomy, pathophysiology, and treatment. Clin Imaging. 2019;57:99-109.
Çalış M, Akgün K, Birtane M, Karacan I, Çalış H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59(1):44-7.
Vahlensieck M. MRI of the shoulder. Eur Radiol. 2000;10(2):242-9.
De Wilde L, Plasschaert F, Berghs B, Van Hoecke M, Verstraete K, Verdonk R. Quantified measurement of subacromial impingement. J Shoulder Elbow Surg. 2003;12(4):346-9.
Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41-50.
Shibuta H, Tamai K, Tabuchi KI. Magnetic resonance imaging of the shoulder in abduction. Clin Orthop Relat Res. 1998;348:107-13.
Ardic F, Kahraman Y, Kacar M, Kahraman MC, Findikoglu G, Yorgancioglu ZR. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006;85(1):53-60.
Christiansen DH, Frost P, Frich LH, Falla D, Svendsen SW. The use of physiotherapy among patients with subacromial impingement syndrome: impact of sex, socio-demographic and clinical factors. PLoS One. 2016;11(3):e0151077.
Nanda R, Gupta S, Kanapathipillai P, Liow RY, Rangan A. An assessment of the inter examiner reliability of clinical tests for subacromial impingement and rotator cuff integrity. Eur J Orthop Surg Traumatol. 2008;18:495-500.
Kvalvaag E, Anvar M, Karlberg AC, Brox JI, Engebretsen KB, Søberg HL, et al. Shoulder MRI features with clinical correlations in subacromial pain syndrome: a cross-sectional and prognostic study. BMC Musculoskelet Disord. 2017;18:1.
MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg. 2000;9(4):299-301.
Gillooly JJ, Chidambaram R, Mok D. The lateral Jobe test: a more reliable method of diagnosing rotator cuff tears. Int J Shoulder Surg. 2010;4(2):41.
Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2012;93(2):229-36.
Pappas GP, Blemker SS, Beaulieu CF, McAdams TR, Whalen ST, Gold GE. In vivo anatomy of the Neer and Hawkins sign positions for shoulder impingement. J Shoulder Elbow Surg. 2006;15(1):40-9.
Roberts CS, Davila JN, Hushek SG, Tillett ED, Corrigan TM. Magnetic resonance imaging analysis of the subacromial space in the impingement sign positions. J Shoulder Elbow Surg. 2002;11(6):595-9.
Downloads
Published
How to Cite
Issue
Section
