Clinical Tests show High Diagnostic Accuracy in the Assessment of Degenerative Full-Thickness Rotator Cuff Tears

Abstract

Introduction Currently, the diagnosis of full-thickness rotator cuff tears (FTCT) relies heavily on imaging. We suggest that clinical examination can reliably be used as a substitute for diagnostic imaging, particularly in relatively older patients who are undergoing conservative management. Our study evaluates the diagnostic value of 5 clinical tests in the assessment of FTCT in secondary care. Methods 115 patients were examined by a consultant shoulder surgeon for suspected FTCT and underwent diagnostic imaging. Clinical examination included the Empty Can test, Resisted External Rotation test, External Rotation Lag test, Belly-press test and Lift-off test. 52 of these patients were referred for shoulder arthroscopy, while the rest were managed conservatively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of these tests were calculated, comparing clinical results with arthroscopic findings. Results We show that in combination these 5 special tests have high diagnostic value for FTCT, with an overall accuracy of 90%. Both the Empty Can test and the Resisted External Rotation test had a sensitivity of 97%. While the External Rotation Lag test had poor accuracy, it was 100% successful at ruling-in tears. The Belly-press and Lift-off tests were 100% sensitive and specific for full-thickness tears of the subscapularis. Discussion and Conclusion Clinical tests for the diagnosis of full-thickness rotator cuff tears have high diagnostic value, comparable to imaging modalities explored in the literature. Overreliance on MRI and ultrasonography may not be justified, particularly in a relatively older population when a rotator cuff tear repair is not scheduled.