Table 1

Summary of studies

Lead author, yearMean age years (range)Mean symptom durationStudy designCriterion standardShPE testLR±LR−Author conclusions
Michener2440.6 (18–83)33.8 monthsProspective blinded studyArthroscopyHawkins-Kennedy
Neer
Painful arc
Empty can
Resisted External rotation/Infraspinatus test
3 or more positive tests		1.63
1.76
2.25
3.90
4.39
2.93		0.61
0.35
0.38
0.57
0.50
0.34		The single tests of painful arc, external rotation resistance, and Neer are useful screening tests to rule out SAIS (subacromial impingement syndrome). The reliability of all tests was acceptable for clinical use. Based on reliability and diagnostic accuracy, the single tests of the painful arc, external rotation resistance, and empty can have the best overall clinical utility. The cut point of 3 or more positive of 5 tests can confirm the diagnosis of SAIS, while less than 3 positive of 5 rules out SAIS.
Miller2555.5 (20–86)37.5 monthsCase-control, same subject, correlation, double-blindUltrasoundExternal rotation lag sign
Drop sign
Internal rotation lag sign		7.2
3.2
6.2		0.60
0.30
0.00		A positive sign would appear to suggest the moderate likelihood of the presence of a full-thickness tear but this conclusion is tenuous based on the small sample size of the study and subsequent wide confidence interval
Kim YS2632.6 (19–54)NACohort studyArthroscopyPassive compression test5.90.21The passive compression test is a useful and accurate technique for predicting superior labral tears of the shoulder joint.
Fodor2757 (20–84)NAProspective, consecutive subjectsUltrasoundNeer
Yocum
Hawkins-Kennedy
Painful arc
4 tests		10.8
8.80
6.50
3.40
1.70		0.48
0.33
0.31
0.41
0.03		The Hawkins-Kennedy test is the most sensitive test for identification of subacromial impingement syndrome, while Neer is most specific. With 4 (+) tests, the specificity increases and the sensitivity decreases. No tests were good at distinguishing stages of subacromial impingement.
Jia28NANARetrospectiveArthroscopyShrug sign
Glenohumeral OA
Adhesive capsulitis
Massive RC tear
Rotator cuff tendinopathy
FTT RC		3.6
1.90
1.50
2.04
1.30		0.12
0.10
0.50
0.08
0.72		The shrug sign is a non-specific physical exam sign for shoulder dysfunction and is more commonly associated with glenohumeral OA, adhesive capsulitis, and massive rotator cuff tear.
Bushnell2924 (16–52)NAprospective pilot studyArthroscopyBony apprehension test for instability7.140.00The bony apprehension test can reliably screen for significant osseous lesions.
Castoldi3050.4 (16–89)NAProspective cohort treatmentArthroscopyExternal rotation lag sign (ERLS) – FTT SS
ERLS – FTT SS & IS
ERLS – FTT TM		28.00
13.86
14.29		0.45
0.03
0.00		The ERLS is highly specific and acceptably sensitive for the diagnosis of full-thickness tears, even in case of an isolated lesion of the supraspinatus tendon.
Silva3155 (24–82)97.5 daysProspectiveMRINeer
Hawkins-Kennedy
Yocum
Jobe
Patte
Gerber
Resisted abduction		0.98
1.23
1.32
1.06
1.50
1.36
0.73		1.10
0.65
0.53
0.87
0.67
0.64
2.10		The Yocum test was the most sensitive for subacromial impingement and the Gerber test for subacromial-subdeltoid bursitis. The Gerber and Patte tests provide the best diagnostic combo. The majority of tests showed low specificity.
Chew3244 (18–75)9.8 monthsprospective cohortUltrasoundNeer
Hawkins-Kennedy
Cross body adduction
Drop arm
Full can
Empty can
Painful arc		1.60
1.30
1.90
3.30
2.40
1.60
3.70		0.60
0.40
0.40
0.80
0.40
0.30
0.40		Diagnosis of supraspinatus pathology may be accomplished with a cluster of three tests: age >39, (+) painful arc, self reported clicking or popping.
Bak3356 FTT, 38 No tear (39–75 FTT; 19–73 control)13 daysProspective diagnostic studyUltrasoundHawkins-Kennedy
Neer
Jobe
Painful arc
Drop arm test
External rotation lag sign
Infraspinatus drop sign
Internal rotation lag sign		1.04
0.92
1.25
100
2.41
5.00
1.50
2.38		0.88
1.14
0.62
1.00
0.71
0.60
0.79
0.79		BEFORE subacromial lidocaine injection: external rotation lag sign or drop arm test are indicative of a FTT supraspinatus; negative lag sign does not preclude a tear.
AFTER subacromial lidocaine injection: specificity improves and sensitivity is reduced for all tests.
Bartsch3458 (SD 11.6)NAProspective, consecutive subjectsArthroscopyLift off test
Internal rotation lag sign
Modified belly press test (BPT)
Belly off sign (BOS)		1.90
1.30
2.75
9.67		0.76
0.64
0.18
0.14		Fifteen percent of the subscapularis tears were not predicted preoperatively by using all of the tests. The modified BPT and the BOS showed the greatest sensitivity. The BOS had the greatest specificity. With the BOS and the modified BPT in particular, upper subscapularis lesions could be diagnosed preoperatively.
Kibler3549 (28–64)NACohort studyArthroscopyBelly press
Upper cut
Bear hug
Yergason's
Speed's
Dynamic labral shear test
Anterior slide
O'Brien's		biceps/SLAP
2.1/.61
3.38/.49
1.95/.54
1.94/.88
2.77/.93
0.38/31.57
0.64/2.63
0.96/3.83		biceps/SLAP
0.81/1.13
0.34/1.40
0.36/1.98
0.74/1.05
0.58/1.03
1.54/.29
1.22/0.64
1.02/.47		The upper cut test shows higher levels of clinical utility for the detection of biceps injuries than traditional tests. The likelihood ratio, however, suggest its individual value is moderate. Therefore, the upper cut & Speed's tests together provide fairly high clinical prediction of arthroscopic biceps pathology. The modified dynamic labral shear test shows the highest level of clinical utility in the diagnosis of SLAP tears when compared to any individual tests. The modified dynamic labral shear test & O’Brien's together show best prediction of SLAP arthroscopic findings.
Chen36NA23 weeksProspective, double-blindUltrasoundYergason's
Speed's
Bicipital groove palpation		1.47
1.55
2.04		0.87
0.63
0.60		All three tests are limited by poor sensitivity with respect to biceps tendinosis.
Fowler374135 weeksCohort/retrospectiveArthroscopyHawkins-Kennedy/RC tendinopathy
Relocation/Bankart lesion
Relocation/Hill-Sachs
O'Brien's/labrum
O'Brien's/SLAP
Apprehension/SLAP
Gerber's/RC tendinopathy		2.10
6.10
4.30
1.05
1.10
1
1.9		0.60
0.20
0.20
0.90
0.80
1
0.9		The diagnostic accuracy of isolated standard shoulder tests in recreational athletes was overall very poor. A positive response gained in one of a combination of clinical tests caused test sensitivity to increase substantially in all pathological conditions, with specificity subsequently plummeting.
Goyal3845 (23–62)2.8 monthsCase-controlUltrasoundSpeed's
Resisted abduction
Resisted external rotation
Resisted internal rotation
Adduction stress		4.6
1.43
NA
26.78
15		0.34
0.26
0.5
0.26
0.45		Sensitivity was good in the clinical diagnosis of supraspinatus lesions and low in other shoulder lesions, especially the infraspinatus and the acromioclavicular joint. Specificity was high for lesions of infraspinatus, subscapularis and the acromioclavicular joint. However, it was fairly good for biceps tendon pathology and very low for the supraspinatus lesions. Physical exam was unable to differentiate rotator cuff tendonitis from tear, and partial-thickness tears from full-thickness tear.
Jia39NANARetrospectiveArthroscopyAC resisted extension
Active compression for SLAP
Active compression for biceps tendinopathy
Active compression for AC joint OA
Anterior Slide
Anterior apprehension for glenohumeral instability
Anterior apprehension for anterior instability
Posterior apprehension
Cross body for RC tendinopathy
Cross body for AC joint OA
Drop arm
External rotation lag sign for massive RC tear
External rotation lag sign for
RC tendinopathy		4.8
1.26
1.26
8.20
2.63
14.50
18.00
19.00
0.88
3.67
2.18
3.18
0.44		0.33
0.81
0.70
0.62
0.62
0.44
0.29
0.82
1.04
0.29
0.39
0.73
1.11		The results of shoulder examinations are variable and statistical analysis may not demonstrate a substantial improvement on the original observations of Codman.
Hawkins-Kennedy for AC joint OA
Hawkins Kennedy for biceps tendinopathy
Lift off for biceps tendinopathy
Lift off for glenohumeral OA
Lift off for RC tendinopathy
Neer for AC joint OA
Neer for biceps tendinopathy
Speed's for biceps tendinopathy
Whipple for massive RC tear
Whipple for RC tendinopathy		0.85
0.89
2.55
2.90
0.48
0.97
1.08
1.52
1.35
1.19		1.18
1.18
0.81
0.79
1.14
1.05
0.88
0.75
0.00
0.61
Kelly4057 (20–70)2 yearsCross-sectional studyUltrasoundNeer
Hawkins-Kennedy
Painful arc of abduction
Abduction weakness
Abduction pain
External rotation weakness
External rotation pain
Empty can weakness
Empty can pain
Full can weakness
Full can pain		0.62
1.48
0.59
0.76
2.21
0.74
3.3
1.56
0.78
1.79
0.46		0.52
1.4
1.24
0.34
1.8
0.74
0.72
1.45
0.73
2.6		The Hawkins-Kennedy test was the most accurate test for diagnosing any degree of subacromial impingement syndrome. The most accurate tests for diagnosing sub-categories of impingement were pain on resisted external rotation and weakness during the full can test for presence of subdeltoid fluid, pain on resisted external rotation for partial-thickness tears and the painful arc test for full-thickness tears. Overall, physical tests have limited diagnostic value.
Kim HA4159 (37–77)16.1 monthsProspectiveUltrasoundEmpty can (SS)
Lift -off (SB)
Yergason's (biceps)		0.64
0.081
4.03		1.34
4.67
0.31		Physical examination used for the diagnosis of shoulder pain had low sensitivity and specificity for the detection of rotator cuff tendon tears.
Kim HA4253 (16–75)10 monthsProspectiveUltrasoundEmpty can (SS)
Patte's (IS)
Lift -off (SB)
Yergason's (biceps)		1.3
2.3
1.3
1.3		0.6
0.5
0.7
0.96		Physical examination of the rotator cuff and biceps had low sensitivity and specificity in the rheumatoid shoulder joint.
Salaffi4358 (23–81)2 monthsProspective, consecutive subjectsUltrasoundHawkins-Kennedy
Empty can
Patte's test
Lift –off
Speed's
SNAPSHOT >3		2.15
1.14
2.43
1.45
2.1
6.1		0.51
0.85
0.5
0.85
0.66
0.3		The sensitivity was low for the clinical diagnosis of all shoulder abnormalities. As calculated through an ROC curve analysis, the Simple Numeric Pain by SHOulder Test (SNAPSHOT) index may improve the clinical examination of the painful shoulder by overcoming the low clinical value of each single maneuver. The SNAPSHOT optimal cut-off point was a score of >3 which increased the specificity and likelihood ratios considerably.
Walsworth4440 (18–83)34Prospective cohortArthroscopyActive compression
Anterior slide
Crank		0.67
2.38
1.35		2.5
0.69
0.71		The combination of popping or catching with a positive crank or anterior slide result or a positive anterior slide result with a positive active compression or crank test result suggests the presence of a labral tear. The combined absence of popping or catching and a negative anterior slide or crank result suggests the absence of a labral tear.
Schlecter4544 (13–84)NARetrospective analysisArthroscopyPassive distraction test (PDT)
Active compression test (ACT)
Anterior slide test
PDT + ACT		8.83
7.38
10.5
7		0.5
0.45
0.81
0.33		The passive distraction test can be used alone or in combo to aid the clinical evaluation and diagnosis of SLAP lesion.
Gillooly4653 (17–83)15Prospective cohortArthroscopyLateral Jobe test
Combined tests*		7.36
4.75		0.21
0.49		The lateral Jobe test had a higher sensitivity than the combined tests (Empty can, strength in ER, and subacromial impingement tests). It is a simple, new technique which can improve the clinical diagnosis of rotator cuff tears; *positive result for the combined tests was taken as weakness on supraspinatus testing, weakness in external rotation and pain on subacromial impingement or a combination of two of these and an age greater than 60 years.
Adams47NAacuteProspectiveX-raysOlecranon-Manubrium Percussion Sign0.15The presence of a normal OMP (olecranon manubrium percussion test) sign does not negate the need for radiographic studies in patients with shoulder injury. The presence of an abnormal OMP sign suggests the need for appropriate radiographic studies.
Carbone4840–50NARetrospectiveCodman's criteria, exam &/or MRICoracoid pain test (Adhesive capsulitis)49.50.01Coracoid pain test is an easy and reliable test for identifying patients with or without adhesive capsulitis.
Ebinger4949 (14–79)chronicProspectiveArthroscopySupine flexion resistance test
Speed's
Active compression		2.6
0.97
1.3		0.29
1.05
0.21		Regarding type II SLAP lesions, the supine flexion resistance test is more specific than the O’Brien's or Speed's test.
Cook5045chronicProspective, case-based, case-controlArthroscopyActive compression
Kim II
Dynamic labral shear
Speed's
Labral tension		1.1
1.2
1.3
1.1
1.2		0.67
0.85
0.4
0.94
0.94		Each of the 5 stand-alone tests and clusters of tests provide minimal to no value in the diagnosis of a SLAP lesion, whether a SLAP-only lesion or a SLAP lesion with or without a concomitant findings reference.
Gill5144 no tear/59 partial tearNACohort studyArthroscopyPalpation
Lift off
Speed's		1.13
2.61
1.51		0.87
0.81
0.75		No single physical examination test can accurately predict the presence of a partial tear of the long head of the biceps tendon.
Kim, E5260 (37–83)>3 monthsProspectiveMRI and arthroscopyEmpty can pain or weakness for RC tear (PTT or FTT)
Empty can weakness for RC tear (PTT or FTT)
Empty can pain for RC tear (PTT or FTT)
Empty can pain and weakness for RC tear (PTT or FTT)
Full can pain or weakness for RC tear (PTT or FTT)
Full can weakness for RC tear (PTT or FTT)
Full can pain for RC tear (PTT or FTT)
Full can pain and weakness for RC tear (PTT or FTT)		1.74
2.62
1.74
2.73
1.96
2.41
2.22
3.28		0.02
0.34
0.13
0.39
0.19
0.34
0.43
0.50		Both the empty can test and full can test were considered to be valuable as screening tests to detect a torn rotator cuff, using the positive signs of pain and weakness separately, in spite of their modest overall accuracy.
Naredo5358 (21–77)12.5 monthsProspectiveUltrasoundEmpty can pain or weakness, SS tear
Empty can pain or weakness, SS tendinopathy
Lift-off, SB tendinopathy
Patte's, IS tendinopathy
Patte's, IS tear		Infinity
1.58
3.1
7.1
7.2		0.81
0.42
0.6
0.3
0.67		The accuracy of clinical diagnosis of periarticular shoulder conditions is low. Physical exam was unable to differentiate rotator cuff tendinitis from tear, and partial thickness tear from full-thickness tear.
Itoi5453 (16–86)NARetrospective case seriesArthroscopySS tear: Full can pain
SS tear: Full can weak (MMT<5)
SS tear: Empty can pain
SS tear: Empty can weak (MMT<5)
IS tear: External rotation strength test pain
IS tear: External rotation strength test weak < 5
SB tear: Lift-off test pain
SB tear: Lift-off test weak <5		1.6
1.8
1.3
1.5
1.17
1.8
1.5
1.9		0.4
0.32
0.55
0.3
0.9
0.3
0.8
0.4		Pain is not useful in locating the sight of a tear. In patients with cuff tendinopathy, the supraspinatus test is most accurate when interpreted with MMT < 5, whereas ERST (infraspinatus) is most accurate with MMT < 4+, and lift-off test (subscapularis) most accurate with MMT <3
Oh55Mid 40's (17–mid 70's)NARetrospective case control studyArthroscopyBiceps groove tenderness
Speed's
Yergason
Relocation
Compression-rotation
Active compression
Kibler
Biceps load II
Anterior apprehension
Whipple		1.7
1.06
0.92
0.96
1.3
1.3
0.7
1.4
1.1
1.1		1.1
1
1
1
0.72
0.7
1.1
0.9
0.9
0.8		No test had a high sensitivity and high specificity; no combination of 2 tests yielded sensitivity/specificity of more than 60%. Combinations of 2 sensitive tests (O'Brien's, Anterior apprehension, Compression rotation) and 1 specific test (Speed's, Yergason, biceps load II) increased the diagnostic accuracy. Requiring 1 of 3 tests to be positive, will result in a sensitivity of ∼ 75%, whereas all 3 positive results in a specificity of ∼ 90%.

  • AC, acromioclavicular; FTT, full-thickness tear; IS, infraspinatus; MMT, manual muscle test; NA, not available; OA, osteoarthritis; PTT, partial-thickness tear; RC, rotator cuff; SB, subscapularis; SLAP, superior labrum anterior posterior; SS, supraspinatus; TM, teres minor.