Chi Kit Yuen1, Ka Leung Mok, Pui Gay Kan. 1. Accident and Emergency Department, Ruttonjee Hospital, Hong Kong, SAR, China. yuenchikit@gmail.com
Abstract
PURPOSE: This study was undertaken to validate the diagnostic values of 9 different physical tests in emergency department patients with primary anterior shoulder dislocation (PASD) to select the best screening test for full-thickness rotator cuff tear (FTRCT) after PASD. METHODS: A prospective analysis of 49 consecutive patients with x-ray-confirmed PASD was performed. All patients were followed at an average of 6.9 days (ranged from 4 to 10 days) in the emergency department. On the day of follow-up, 9 physical tests (namely, Jobe test, external rotation lag sign test, infraspinatus muscle strength test, dropping test, drop test, liftoff test, internal rotation lag sign test, belly-press test, and belly-off test) followed by shoulder ultrasound scan were performed to detect FTRCT. RESULTS: The prevalence of FTRCT after PASD is 37% (95% confidence interval [CI], 24%-52%). Fourteen percent of the patients with PASD were complicated with isolated supraspinatus tendon tear, whereas 22% were complicated with supraspinatus tendon tear combined with subscapularis and/or infraspinatus tendon tear. Jobe test has the highest sensitivity among the 9 physical tests being evaluated. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test, and likelihood ratio for negative test of Jobe test as a screening test for FTRCT after PASD are 89% (95% CI, 64%-98%), 55% (95% CI, 36%-72%), 53% (95% CI, 35%-71%), 89% (95% CI, 65%-98%), 1.97 (95% CI, 1.29-2.99), and 0.20 (95% CI, 0.05-0.79), respectively. CONCLUSIONS: The prevalence of FTRCT after PASD is 37% (95% CI, 24%-52%). Jobe test has the highest sensitivity (89% CI, 64%-98%) among the tests.
PURPOSE: This study was undertaken to validate the diagnostic values of 9 different physical tests in emergency department patients with primary anterior shoulder dislocation (PASD) to select the best screening test for full-thickness rotator cuff tear (FTRCT) after PASD. METHODS: A prospective analysis of 49 consecutive patients with x-ray-confirmed PASD was performed. All patients were followed at an average of 6.9 days (ranged from 4 to 10 days) in the emergency department. On the day of follow-up, 9 physical tests (namely, Jobe test, external rotation lag sign test, infraspinatus muscle strength test, dropping test, drop test, liftoff test, internal rotation lag sign test, belly-press test, and belly-off test) followed by shoulder ultrasound scan were performed to detect FTRCT. RESULTS: The prevalence of FTRCT after PASD is 37% (95% confidence interval [CI], 24%-52%). Fourteen percent of the patients with PASD were complicated with isolated supraspinatus tendon tear, whereas 22% were complicated with supraspinatus tendon tear combined with subscapularis and/or infraspinatus tendon tear. Jobe test has the highest sensitivity among the 9 physical tests being evaluated. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test, and likelihood ratio for negative test of Jobe test as a screening test for FTRCT after PASD are 89% (95% CI, 64%-98%), 55% (95% CI, 36%-72%), 53% (95% CI, 35%-71%), 89% (95% CI, 65%-98%), 1.97 (95% CI, 1.29-2.99), and 0.20 (95% CI, 0.05-0.79), respectively. CONCLUSIONS: The prevalence of FTRCT after PASD is 37% (95% CI, 24%-52%). Jobe test has the highest sensitivity (89% CI, 64%-98%) among the tests.
Authors: Nitin B Jain; Jennifer Luz; Laurence D Higgins; Yan Dong; Jon J P Warner; Elizabeth Matzkin; Jeffrey N Katz Journal: Am J Phys Med Rehabil Date: 2017-03 Impact factor: 2.159