Physical examination tests in the acute phase of shoulder injuries with negative radiographs: a diagnostic accuracy study

Review written by Dr Michael Reiman info

Key Points

  1. No pain with resisted abduction, the ability to abduct >90 degrees, no weakness with the small finger test, and no weakness of external rotation were helpful to rule out full-thickness rotator cuff tears.
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BACKGROUND AND OBJECTIVE

The evidence supporting shoulder physical examination tests has been considered insufficient in reviews and meta-analyses. Rotator cuff tears may easily be missed in patients with acute shoulder trauma, as these individuals are often discharged when skeletal imaging is negative. However, rotator cuff pathologies are often found on follow-up consultation (1).

It has also been suggested that diagnostic tests be employed by emergency room physicians on patients who were not referred to a specialist (2). One primary reason for this is the fact that approximately half of shoulder injuries in an emergency department are soft tissue injuries and being able to accurately diagnose a rotator cuff pathology is important for patient care (3).

The aim of the present study was to assess the accuracy in predicting or ruling out acute rotator cuff tears in the first-line health care.

Rotator cuff tears may easily be missed in patients with acute shoulder trauma, as these individuals are often discharged when skeletal imaging is negative.
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The inability to abduct more than 90 degrees and weakness in external rotation are more useful to help rule out full-thickness rotator cuff tears when the findings of the tests are negative.

METHODS

A prospective diagnostic accuracy study was conducted at a combined primary care walk-in clinic and secondary care orthopedic emergency department.

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