Physical Examination Tests of the Shoulder: A Systematic Review with Meta-analysis of Individual Tests

Eric J Hegedus ^1*, Adam Goode ², Skye Campbell ³, Amy Morin ⁴, Michael Tamaddoni ⁴, Claude T Moorman ⁴ and Chad Cook ⁴

¹ Duke University, Uruguay
² Duke University, Vanuatu
³ Duke University, Uzbekistan
⁴ Duke University, United States

^* To whom correspondence should be addressed. E-mail: heged001{at}mc.duke.edu.

Accepted 9 August 2007

Abstract

Ojective: To compile and critique research on the diagnostic accuracy of individual orthopedic physical examination tests in a manner which would allow clinicians to judge whether these tests are valuable to their practice.

Methods: A computer-assisted literature search of MEDLINE, CINAHL, and SPORTDiscus databases (1966 to October 2006) using keywords related to diagnostic accuracy of physical examination tests of the shoulder. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to critique the quality of each paper. Meta-analysis through meta-regression of the diagnostic odds ratio (DOR) was performed on the Neer test for impingement, the Hawkins-Kennedy test for impingement, and the Speed test for superior labral pathology.

Results: Forty-five studies were critiqued with only half demonstrating acceptable high quality and only 2 having adequate sample size. For impingement, meta-analysis revealed pooled sensitivity and specificity for the Neer test was 79% and 53%, respectively, and for the Hawkins-Kennedy test was 79% and 59%, respectively. For superior labral (SLAP) tears, the summary sensitivity and specificity of Speed’s test were 32% and 61%, respectively. Regarding OST’s where meta-analysis was not possible either due to a lack of sufficient studies or heterogeneity between studies, the list of OST’s that demonstrate both high sensitivity and high specificity is short: Hornblowers’s sign and the External Rotation Lag sign for tears of the rotator cuff, Biceps Load II for superior labral anterior to posterior (SLAP) lesions, and Apprehension, Relocation, and Anterior Release for anterior instability. Even these tests have been under-studied or are from lower quality studies or both. No tests for impingement or acromioclavicular (AC) joint pathology demonstrated significant diagnostic accuracy.

Conclusion: Based on pooled data, the diagnostic accuracy of the Neer test for impingement, the Hawkins-Kennedy test for impingement, and the Speed test for labral pathology is limited. There is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the numerous physical examination tests of the shoulder. Currently, almost without exception, there is a lack of clarity with regard to whether common OST’s used in clinical examination are useful in differentially diagnosing pathologies of the shoulder.

Key Words: diagnostic accuracy, physical examination, sensitivity and specificity, shoulder, systematic review

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Commentary on "Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests"

George Murrell
Br. J. Sports Med. 2008 42: 92. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Jia, X., Petersen, S. A., Khosravi, A. H., Almareddi, V., Pannirselvam, V., McFarland, E. G. (2009). Examination of the Shoulder: The Past, the Present, and the Future. JBJS 91: 10-18 [Full Text]  
• Khan, K M (2009). Mid-year review: physical inactivity universally accepted as the biggest public health problem of the 21st century, shoulder exam challenges, and progress against the scourges of anterior knee pain and ACL injuries. Br. J. Sports. Med. 43: 469-470 [Full Text]  
• Khan, K. M (2009). New video evidence links trunk and knee motion in non-contact ACL injury. Br. J. Sports. Med. 43: 391-391 [Full Text]  
• Cook, J. (2009). In search of the tendon holy grail: predictable clinical outcomes. Br. J. Sports. Med. 43: 235-235 [Full Text]  
• Lewis, J S (2009). Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?. Br. J. Sports. Med. 43: 259-264 [Abstract] [Full Text]  
• Yoo, J. C., Lee, Y. S., Tae, S. K., Park, J. H., Park, J. W., Ha, H. C. (2008). Magnetic Resonance Imaging Appearance of a Repaired Capsulolabral Complex After Arthroscopic Bankart Repair. Am J Sports Med 36: 2310-2316 [Abstract] [Full Text]  
• Cools, A M, Cambier, D, Witvrouw, E E (2008). Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br. J. Sports. Med. 42: 628-635 [Abstract] [Full Text]