Distension test in passive external rotation: Validation of a new clinical test for the early diagnosis of shoulder adhesive capsulitis

Abstract

ObjectiveThe aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). Materials and methodsThe DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. ResultsThe DTPER showed a sensitivity of 100% (95% CI: 91.8–100%) and a specificity of 90% (95% CI: 82.4–94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI: 5.5–19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. DiscussionThe DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis).