Diagnostic accuracy of clinical tests and grading the quality of evidence
| Clinical test | Likelihood ratio | Positive and negative predicative values | Diagnostic accuracy | ||
| High* | Moderate | Low/very low | |||
| Arthroscopy used as reference standard | |||||
| Subacromial impingement | |||||
| Composit test (combination of Hawkins-Kennedy, Neer, Painful arc, Empty can/Jobe, external rotation against resistance)33 | LR+=2.93 | Low quality of evidence | |||
| LR−=0.34 | Low quality of evidence | ||||
| Internal posterosuperior impingement | |||||
| Posterior impingement test37 | LR+=5.0 | N/A* | |||
| LR−=0.29 | N/A† | ||||
| Anterior instability | |||||
| Apprehension33 | LR+=17.21 | Moderate quality of evidence | |||
| LR−=0.39 | Low quality of evidence | ||||
| Relocation33 | LR+=5.48 | Very low quality of evidence | |||
| LR−=0.55 | Very low quality of evidence | ||||
| Surprise33 | LR+=5.42 | Very low quality of evidence | |||
| LR−=0.25 | Very low quality of evidence | ||||
| Apprehension + relocation33 | LR+=39.68 | Moderate quality of evidence | |||
| LR−=0.19 | Moderate quality of evidence | ||||
| SLAP | |||||
| Biceps load II35 ‡ | LR+=26.38 | PPV=92.1 | Moderate quality of evidence | ||
| LR−=0.11 | NPV=95.5 | Moderate quality of evidence | |||
| Biceps-Labrum complex injuries | |||||
| O’Brien’s active compression; Inside36 § | LR+=1.62 | PPV=63.2 | Low quality of evidence | ||
| LR−=0.27 | NPV=77.8 | Low quality of evidence | |||
| O’Brien’s active compression; Junctional36 § | LR+=2.48 | PPV=82.4 | Low quality of evidence | ||
| LR−=0.15 | NPV=77.8 | Low quality of evidence | |||
| O’Brien’s active compression; Bicipital tunnel36 § | LR+=2.00 | PPV=65.7 | Low quality of evidence | ||
| LR−=0.08 | NPV=92.6 | Moderate quality of evidence | |||
| Throwing test; Inside36 § | LR+=2.32 | PPV=71.2 | Low quality of evidence | ||
| LR−=0.36 | NPV=72.1 | Low quality of evidence | |||
| Throwing test; Junctional36 § | LR+=3.42 | PPV=86.5 | Moderate quality of evidence | ||
| LR−=0.35 | NPV=60.5 | Low quality of evidence | |||
| Throwing test; Bicipital tunnel36 § | LR+=2.09 | PPV=66.7 | Low quality of evidence | ||
| LR−=0.40 | NPV=72.1 | Low quality of evidence | |||
| Bicipital tunnel palpation; Inside36 § | LR+=1.92 | PPV=67.2 | Low quality of evidence | ||
| LR−=0.16 | NPV=85.7 | Moderate quality of evidence | |||
| Bicipital tunnel palpation; Junctional36 § | LR+=3.43 | PPV=86.6 | Moderate quality of evidence | ||
| LR−=0.09 | NPV=85.7 | Moderate quality of evidence | |||
| Bicipital tunnel palpation; Bicipital tunnel36 § | LR+=2.24 | PPV=68.2 | Low quality of evidence | ||
| LR−=0.04 | NPV=96.4 | Moderate quality of evidence | |||
| Yergasons test; Inside36 § | LR+=2.13 | Low quality of evidence | |||
| LR−=0.76 | Low quality of evidence | ||||
| Yergasons test; Junctional36 § | LR+=6.57 | Low quality of evidence | |||
| LR−=0.83 | Low quality of evidence | ||||
| Yergasons test; Bicipital tunnel36 § | LR+=12.43 | Moderate quality of evidence | |||
| LR−=0.75 | Low quality of evidence | ||||
| MRI or ultrasound used as reference standard | |||||
| Rotator cuff injury | |||||
| Painful Arc34 | LR+=3.70 | Low quality of evidence | |||
| LR−=0.36 | Low quality of evidence | ||||
| Gerber/Lift-off test34 | LR+=1.40–1.50 | Very low quality of evidence | |||
| LR−=0.63–0.85 | Very low quality of evidence | ||||
| External rotation against resistance34 | LR+=2.60 | Low quality of evidence | |||
| LR−=0.49 | Low quality of evidence | ||||
| Full can34 | LR+=2.40 | Low quality of evidence | |||
| LR−=0.37 | Low quality of evidence | ||||
| Empty can/Jobe34 | LR+=1.30 | Very low quality of evidence | |||
| LR−=0.64 | Very low quality of evidence | ||||
| Full rotator cuff rupture | |||||
| External rotation lag34 | LR+=7.20 | Low quality of evidence | |||
| LR−=0.57 | Low quality of evidence | ||||
| Internal rotation lag34 | LR+=5.60 | Low quality of evidence | |||
| LR−=0.04 | Moderate quality of evidence | ||||
| Drop sign34 | LR+=3.20 | Low quality of evidence | |||
| LR−=0.35 | Low quality of evidence | ||||
*Tests that are considered to highly important in the choice of treatment were only downgraded one step in accordance with the GRADE approach for diagnostic studies.
†The article by Meister et al was not obtained in full text hindering risk of bias assessment.
‡Prevalence of SLAP injury=30.7%.
§Prevalence of biceps-labrum complex injuries=70%.
GRADE, Grading of Recommendations Assessment, Development, and Evaluation; LR−, negative likelihood ratio; LR+, positive likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.