Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleThe 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
Section snippets
Methods
From February 1998 until January 2001, a total of 104 patients who presented to the emergency department with an acute injury to a previously healthy shoulder were included in this prospective diagnostic investigation. The inclusion criteria are listed in Table 1. The flow diagram is shown in Fig 1.
Results
The Hawkins sign, Neer sign, Jobe test, and painful arc test had high sensitivity (0.83, 0.70, 0.74, and 0.97, respectively) but low specificity (0.23, 0.36, 0.61, and 0.05, respectively) for acute full-thickness supraspinatus tear (Table 4). The DAT, ERLS, IDS, and IRLS, on the contrary, showed low sensitivity (0.37, 0.39, 0.43, and 0.39, respectively) but high specificity (0.86, 0.91, 0.73, and 0.83, respectively) (Table 4). Specificity improved for all tests after SAL, whereas the
Discussion
The purpose of this study was to investigate the ability of clinical tests to detect acute complete ruptures of the supraspinatus tendon and, in addition, to evaluate whether administration of lidocaine in the subacromial space (SAL) would add to the clinical information. We found that the classical DAT and the Hertel lag signs (ERLS, IDS, and IRLS) had low sensitivity in this study with respect to cases of acute FTT of the supraspinatus tendon. The sensitivity dropped further after SAL,
Conclusions
A positive lag sign (ERLS or DAT) is indicative of a full-thickness supraspinatus tear. A negative lag sign does not preclude a tear. After an SAL, the specificity improves whereas the sensitivity is reduced. Overall, in patients with suspected acute rotator cuff tear, clinical tests cannot stand alone in the evaluation the first weeks after an acute injury.
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Deciphering acute shoulder trauma with normal initial X-ray: Contributions of ultrasonography and MRI
2021, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :The present results showed that simple contusion or sprain accounted for only 29% of shoulder traumas with normal X-ray, including 14.5% with no signs on MRI, thus justifying complementary diagnostic imaging. Pain makes clinical examination poorly contributive [3,4,20–22], except in extensive cuff tear, where absence of elevation is an alert. US is probably not the examination of choice, especially in young subjects, in whom it overlooked all cases of instability.
Deciphering acute shoulder trauma with normal initial X-ray: Contribution of ultrasonography and MRI
2021, Revue de Chirurgie Orthopedique et TraumatologiqueEditorial Commentary: First They Came for My Examination Skills: Diagnostic Injections of the Biceps Sheath Are No Substitute for a Careful Collaboration of History, Examination, and Clinical Acumen
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryThe new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears
2020, Journal of Shoulder and Elbow SurgeryDiagnostic Value of Clinical Tests for Supraspinatus Tendon Tears
2018, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Various clinical tests have been developed for the clinical assessment of the supraspinatus tendon.8-10,24 Several studies have investigated the diagnostic value of these tests, although different symptoms, such as pain, weakness, or both, were used to interpret the results.11,12,33 It is still unclear which of these symptoms is more accurate.12,13
The authors report no conflict of interest.