Best Practice Case Studies-Case 154 Asset 5 Physical Examination of the Shoulder

Pdf Summary

This systematic review and meta-analysis evaluated the diagnostic accuracy of individual physical examination tests for shoulder disorders. The authors searched major databases and included 45 English-language studies, assessing study quality with QUADAS. Overall, the evidence base was limited: only about half of the studies were judged high quality, and only two had adequate sample sizes.<br /><br />Meta-analysis was possible for three tests. For shoulder impingement, the Neer test and Hawkins-Kennedy test both showed only moderate sensitivity (79%) but poor specificity (53% and 59%). Their diagnostic odds ratios were around 1, meaning they did not meaningfully distinguish patients with and without impingement. For superior labral anterior-posterior (SLAP) tears, the Speed test performed poorly, with sensitivity of 32% and specificity of 61%, and no diagnostic utility beyond chance.<br /><br />For other shoulder conditions, meta-analysis could not be done because of too few studies or too much heterogeneity. Still, some tests showed promise in single or small studies: hornblower’s sign and external rotation lag sign for rotator cuff tears, bear-hug and belly press tests for subscapularis tears, biceps load II for SLAP lesions, and apprehension, relocation, and anterior release tests for anterior instability. No tests for impingement or acromioclavicular joint pathology showed strong overall diagnostic accuracy.<br /><br />The main conclusion is that many commonly used shoulder special tests have limited ability to accurately identify the underlying pathology. The authors call for larger, better-designed prospective studies. In practice, these tests may be more useful when combined with history and other findings than when used alone.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 154

Topic Shoulder

Keywords

4th Edition

shoulder disorders

diagnostic accuracy

physical examination tests

systematic review

meta-analysis

Neer test

Hawkins-Kennedy test

SLAP tears

rotator cuff tears

QUADAS

4th Edition, Case 154

Shoulder