Abstract
The purpose of this review is to discuss the accuracy of orthopedic tests in detecting rotator cuff tears and retears, while developing new, more sensitive and specific clinical exam tools. With the ever-increasing population and consequent increased incidence of shoulder pathology, there is a vertical trend in medical cost as physical diagnosis is evermore substituted by imaging diagnosis. Unfortunately, clinical examination maneuvers have demonstrated variable specificity and sensitivity for primary rotator cuff tears, leading to the dependance of imaging modalities. Currently, there is no clinical exam maneuver that accurately confirms clinical suspicions of a rotator cuff retear following repair. Future studies focusing on the sensitivity and specificity of special orthopedic tests identifying retears would support a more accurate clinical diagnosis of rotator cuff retears. The goal of this narrative review is to outline the current trends in diagnosing rotator cuff tears and retears while demonstrating how current imaging studies have shown especially poor reliability in detecting this injury. This research project intends to present how a thorough and proper clinical exam that incorporates several orthopedic special tests, it can achieve an early and non-expensive accurate diagnosis.
Highlights
Over time, the incidence of rotator cuff repair has increased from about 23 to 83 people per 100,000 between 1995 and 2009 and continues to increase [1]
The purpose of this review is to discuss the accuracy of orthopedic tests in detecting rotator cuff tears and retears, while developing new, more sensitive and specific clinical exam tools
Future studies focusing on the sensitivity and specificity of special orthopedic tests identifying retears would support a more accurate clinical diagnosis of rotator cuff retears
Summary
The incidence of rotator cuff repair has increased from about 23 to 83 people per 100,000 between 1995 and 2009 and continues to increase [1]. An increased incidence of rotator cuff repair leads to an increase in diagnostic and pre-operative expenses in tools used for accurately diagnosing rotator cuff tears. The incidence and prevalence of rotator cuff tears increase with age. The prevalence of cuff defects in patients over the age of 80 can reach upwards of 60% [3]. Many of these tears are initially asymptomatic, many studies have demonstrated that propagation of the defect increases, leading to pain in a large number of individuals
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