Accuracy of physical examination in subacromial impingement syndrome

In this study of 55 patients, the authors studied five findings and concluded, “The cut point of 3 or more positive of 5 tests can confirm the diagnosis…, while less than 3 positive of 5 rules out.” If you look at the accuracies and the predictive values below, I think you will agree these results are overstated and not very helpful clinically. The shoulder is still very hard to examine.
Diagnostic Accuracy for Impingement Shoulder Tests among 55 patients with a prevalence of impingement of 29%
Finding Sensitivity (%) Specificity (%) Kappa Positive predictive value Negative predictive value
Hawkins-Kennedy 63 62 39 40 61
Neer 81 54 40 42 13
Painful arc 75 67 45 48 13
Empty can (Jobe) 50 87 47 61 19
External rotation resistance 56 87 67 64 17
3 or more of 5 findings positive 75 74 54 12

How to do the tests

YouTube videos demonstrating the tests

This has been added to http://en.citizendium.org/wiki/Shoulder_pain

Citation

Michener LA, Walsworth MK, Doukas WC, & Murphy KP (2009). Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Archives of physical medicine and rehabilitation, 90 (11), 1898-903 PMID: 19887215

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s


%d bloggers like this: