Is it time to put special tests for rotator cuff-related shoulder pain out to pasture?

Review written by Dr Teddy Willsey info

Key Points

  1. Shoulder special tests should be viewed as pain provocation tests, rather than tools to arrive at specific diagnoses.
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BACKGROUND & OBJECTIVE

Rotator cuff-related diagnoses account for over a third of all shoulder pain, however the methods by which clinicians arrive at these diagnoses may be dubious (1). Previous systematic reviews have shown shoulder special tests offer greater utility when clustered together and should be reserved for identifying the degree and severity of symptoms, rather than pathology itself (2). In this viewpoint paper, the authors discuss the alarmingly low validity of shoulder special tests in their ability to identify the structural and pathological source of pain.

Rotator cuff-related diagnoses account for over a third of all shoulder pain.
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It is clear special tests should not be used to provide a definitive structural diagnosis or inform a surgical or more invasive plan of care.

METHODS

The most common way to investigate the validity of a clinical test is to compare it to a previously established gold standard. Validating shoulder special tests is near impossible due to the low reliability of their reference standard, the MRI.

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