Abstract
ObjectiveTo examine the diagnostic accuracy of standard clinical tests for the shoulder in recreational athletes with activity related pain.DesignCohort study with index test of clinical examination and reference standard of arthroscopy.SettingSports Medicine clinic in Sheffield, U.K.Participants101 recreational athletes (82 male, 19 female; mean age 40.8 ± 14.6 years) over a six year period.InterventionsBilateral evaluation of movements of the shoulder followed by standardized shoulder tests, formulation of clinical diagnosis and shoulder arthroscopy conducted by the same surgeon.Main Outcome MeasurementsSensitivity, specificity, likelihood ratio for a positive test and over-all accuracy of clinical examination was examined retrospectively and compared with arthroscopy.ResultsIsolated pathology was rare, most patients (72%) having more than one injury recorded. O'Brien's clinical test had a mediocre sensitivity (64%) and over-all accuracy (54%) for diagnosing SLAP lesions. Hawkins test and Jobe's test had the highest but still not impressive over-all accuracy (67%) and sensitivity (67%) for rotator cuff pathology respectively. External and internal impingement tests showed similar levels of accuracy. When a positive test was observed in one of a combination of shoulder tests used for diagnosing SLAP lesions or rotator cuff disease, sensitivity increased substantially whilst specificity decreased.ConclusionsThe diagnostic accuracy of isolated standard shoulder tests in recreational athletes was over-all very poor, potentially due to the majority of athletes (71%) having concomitant shoulder injuries. Most likely, this means that many of these injuries are missed in general practice and treatment is therefore delayed. Clinical examination of the shoulder should involve a combination of clinical tests in order to identify likely intra articular pathology which may warrant referral to specialist for surgery.
Highlights
Athletic injuries to the shoulder are both common and unique, being both difficult to diagnose and manage [1]
The diagnostic accuracy of isolated standard shoulder tests in recreational athletes was over-all very poor, potentially due to the majority of athletes (71%) having concomitant shoulder injuries. This means that many of these injuries are missed in general practice and treatment is delayed
Clinical examination of the shoulder should involve a combination of clinical tests in order to identify likely intra articular pathology which may warrant referral to specialist for surgery
Summary
Athletic injuries to the shoulder are both common and unique, being both difficult to diagnose and manage [1]. The majority of shoulder injuries occur from direct or indirect trauma or as a result of repetitive use [1] with the most frequently presenting shoulder conditions at primary care being rotator cuff pathology, glenohumeral and acromioclavicular joint disorders and pain referral from the neck [2]. The most commonly reported shoulder pathology in older athletes is rotator cuff pathology [1,2] with 85% of patients at primary care level being diagnosed with this pathology [3]. Whilst numerous clinical examination tests for the shoulder exists, some of which were designed to identifying specific disorders, such as O’Brien’s test for labral lesions [6], difficulty exists in diagnosing and differentiating shoulder disorders by one single test [7]
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