Full thickness rotator cuff tears, Value of clinical tests
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Transcript of Full thickness rotator cuff tears, Value of clinical tests
Hanneke van der WeijdenCoventry University 2013
DYSFUNCTION
(Clinical tests)
Subscapularis
Partial tear
Full thickness tear
Index
• Causes• Gold Standard• Discussion of tests• Clinical
implecations/conclusion• Questions
Causes
-Lifestyle, overuse
-Trauma
Degeneration:
12.8 % >50
25.6% > 60
45.8% > 70
50% > 80
(Yamamoto et al 2010)
Diagnosis:
Gold Standard
MRI
(Koel and Van der Tas 2008)
SN: 0.81- 0.92SP: 0.83- 0.97+LR: 5.0-27.86-LR: 0.22-0.09 (N=4)
Diagnosis Gold Standard
(Koel and Van der Tas 2008)
Musculoskeletal Ultrasound
SN: 0.24- 0.99SP: 0.61- 0.99+LR: 0.62-95-LR: 1.25-0.01(N=15)
Subjective Findings
•Trauma•Night pain•Weakness•> 35 years•Lateral of anterior shoulder pain•Loss of function
Clinical Tests
Empty Can
SN: 0.76 SP: 0.39
Bak et al 2010 (HR)
FTT Suprapinatus
External Rotation Lag Sign
Supraspinatus SN: 0.45-0.56 SP: 0.91-0.98 Infraspinatus SN: 0.46-0.97 SP: 0.93-0.94Teres Minor SN: 1.0 SP: 0.93
FTT SupraspinatusFTT infraspinatusFTT Teres Minor
Bak et al 2010 (HR)Castildo et al 2009 (LR)Miller et al 2008 (MR)Jia et al 2009 (HR)
Internal Rotation Lag Sign
SN: 0.31 SP: 0.87
Bak et al 2010 (HR)
FTT Supraspinatus
Supraspinatus SN: 0.45-0.73 SP: 0.70-0.77Infraspinatus SN: 0.45 SP: 0.77
Bak et al 2010 (HR) Miller et al 2008(MR)
FTT SupraspinatusFTT Infraspinatus
Sign
Hawkins-Kennedy Test
SN: 0.77 SP: 0.26 Bak et al 2010 (HR)
FTT Supraspinatus
Neer Test
SN: 0.60 SP: 0.35
Bak et al 2010 (HR)
FTT Suprapsinatus
Painfull Arc
SN: 0.96 SP: 0.04
Bak et al 2010 (HR)
FTT supraspinatus
Good
Ext Rot Lag Sign(ter min, -)
Painful arc (+)
Int Rot Lag Sign(-)
Average
Empty can (+)
Drop arm (-)
Hawkins-Kennedy (+)
Poor
Neer
Subjective: Night pain, Location pain, Trauma, Weakness, Loss of function
Positive special tests: Empty Can, Hawkins-Kennedy, Painfull arc
Full Thickness Tear Rotator Cuff
Negative special tests:
External Rot Lag Sign
Internal Rot Lag Sign
Drop Arm
No
Full
Thickness
Tear
References
• Bak K., Sorenson A.K., Jorgersen U. (2010) The value of clinical tests in acute full-thickness tears of the supraspinatus tendon: does a subarcomial lidocaine injection help clinical diagnosis? A prospective study. Arthroscopy (26) 734-742
• Castildo F., Bionna D., Hertel R., External rotation lag sign revisited: Accuracy for diagnosis of full thickness supraspinatus tear. Journal of Shouder and Elbow Surgery. (18) 529-34
• Hegedus E. (2012) Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British Journal of Sport Medicine. 964-978
• Jia X., Petersen S.A., Khosravi A.H. (2009) Examination of the shoulder: the past, the present, and the future. Journal for bone and joint surgery. Suppl (6) 10-18
• Miller C.A., Forrester G.A., Lewis J.S. (2008) The validity of the lag signs in diagnosis full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Ther Rehabil. (89) 1898-1903
• Yamamoto A., Takagishi K., Osawa T., Yanagawa T., Nakajima D., Shitare H., Kobayashi T. (2010) Prevalence and risk of rotator cuff tear in the general population. Journal of shoulder and elbow surgery. (19) 116-120