Original ArticlesAn analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs*,**
Section snippets
Materials and methods
Because there is no peer-reviewed method of evaluating the subacromial bursa for information, we formulated criteria for “appearances suggestive of subacromial tendinitis and bursitis.” These include (1) erythema and bleeding of subacromial tissue, (2) swelling and difficult visualization, and (3) vascular engorgement of the bursal sides of the rotator cuff, causing bleeding from the surface of the cuff. All of these had to be present for our definition to be met.
Information on 85 consecutive
Results
Patient age ranged from 16 to 72 years; the average age was 40 years. Seventy-three percent of the patients were male and 27% were female. The specificity, sensitivity, positive predictive value, and negative predictive value of the Neer and Hawkins impingement signs were calculated for the clinical diagnosis of rotator cuff bursitis and rotator cuff pathosis, as shown in Tables I-III.Sign Sensitivity(%) Specificity (%) Positive predictive value (%) Negative predictive value (%) Neer 75 47.5 36
Discussion
Many shoulder tests today are in wide use with no documentation of their diagnostic accuracy. Our attempt here is to analyze these tests with respect to a syndrome that is difficult to define. Gartsman2 has stated that impingement syndrome is a clinical diagnosis and its definition therefore somewhat imprecise. He has further indicated a belief that many people have painful impingement without incitement of any inflammatory reaction. With this in mind, one can see an obvious weakness in our
Conclusion
We are assured that when these signs are used, a negative test goes a long way toward ruling out possible rotator cuff tendinitis or tearing. However, the possibility of other pathosis exists when the tests are positive. We encourage further study that would look at other tests, particularly in advance of their widespread use in clinical practice.
Acknowledgements
We thank Ahmed Abdoh, MD, BCh, MSPH, MPH, PhD, clinical epidemiologist, for his statistical analysis of this article.
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Cited by (0)
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Reprint requests: Peter B. MacDonald, MD, St Boniface General Hospital, 409 Tache Ave, Z-3043, Winnipeg, MB R2H 2A6, Canada.
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J Shoulder Elbow Surg 2000;9:299-301.