Hanneke van der WeijdenCoventry University 2013

DYSFUNCTION

(Clinical tests)

Subscapularis

Partial tear

Full thickness tear

Index

• Causes• Gold Standard• Discussion of tests• Clinical

implecations/conclusion• Questions

Causes

-Lifestyle, overuse

-Trauma

Degeneration:

12.8 % >50

25.6% > 60

45.8% > 70

50% > 80

(Yamamoto et al 2010)

Diagnosis:

Gold Standard

MRI

(Koel and Van der Tas 2008)

SN: 0.81- 0.92SP: 0.83- 0.97+LR: 5.0-27.86-LR: 0.22-0.09 (N=4)

Diagnosis Gold Standard

(Koel and Van der Tas 2008)

Musculoskeletal Ultrasound

SN: 0.24- 0.99SP: 0.61- 0.99+LR: 0.62-95-LR: 1.25-0.01(N=15)

Subjective Findings

•Trauma•Night pain•Weakness•> 35 years•Lateral of anterior shoulder pain•Loss of function

Clinical Tests

Empty Can

SN: 0.76 SP: 0.39

Bak et al 2010 (HR)

FTT Suprapinatus

External Rotation Lag Sign

Supraspinatus SN: 0.45-0.56 SP: 0.91-0.98 Infraspinatus SN: 0.46-0.97 SP: 0.93-0.94Teres Minor SN: 1.0 SP: 0.93

FTT SupraspinatusFTT infraspinatusFTT Teres Minor

Bak et al 2010 (HR)Castildo et al 2009 (LR)Miller et al 2008 (MR)Jia et al 2009 (HR)

Internal Rotation Lag Sign

SN: 0.31 SP: 0.87

Bak et al 2010 (HR)

FTT Supraspinatus

Supraspinatus SN: 0.45-0.73 SP: 0.70-0.77Infraspinatus SN: 0.45 SP: 0.77

Bak et al 2010 (HR) Miller et al 2008(MR)

FTT SupraspinatusFTT Infraspinatus

Sign

Hawkins-Kennedy Test

SN: 0.77 SP: 0.26 Bak et al 2010 (HR)

FTT Supraspinatus

Neer Test

SN: 0.60 SP: 0.35

Bak et al 2010 (HR)

FTT Suprapsinatus

Painfull Arc

SN: 0.96 SP: 0.04

Bak et al 2010 (HR)

FTT supraspinatus

Good

Ext Rot Lag Sign(ter min, -)

Painful arc (+)

Int Rot Lag Sign(-)

Average

Empty can (+)

Drop arm (-)

Hawkins-Kennedy (+)

Poor

Neer

Subjective: Night pain, Location pain, Trauma, Weakness, Loss of function

Positive special tests: Empty Can, Hawkins-Kennedy, Painfull arc

Full Thickness Tear Rotator Cuff

Negative special tests:

External Rot Lag Sign

Internal Rot Lag Sign

Drop Arm

No

Full

Thickness

Tear

References

• Bak K., Sorenson A.K., Jorgersen U. (2010) The value of clinical tests in acute full-thickness tears of the supraspinatus tendon: does a subarcomial lidocaine injection help clinical diagnosis? A prospective study. Arthroscopy (26) 734-742

• Castildo F., Bionna D., Hertel R., External rotation lag sign revisited: Accuracy for diagnosis of full thickness supraspinatus tear. Journal of Shouder and Elbow Surgery. (18) 529-34

• Hegedus E. (2012) 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. British Journal of Sport Medicine. 964-978

• Jia X., Petersen S.A., Khosravi A.H. (2009) Examination of the shoulder: the past, the present, and the future. Journal for bone and joint surgery. Suppl (6) 10-18

• Miller C.A., Forrester G.A., Lewis J.S. (2008) The validity of the lag signs in diagnosis full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Ther Rehabil. (89) 1898-1903

• Yamamoto A., Takagishi K., Osawa T., Yanagawa T., Nakajima D., Shitare H., Kobayashi T. (2010) Prevalence and risk of rotator cuff tear in the general population. Journal of shoulder and elbow surgery. (19) 116-120