Interexaminer differences in the traction test of the superior oblique tendon

The traction test of the superior oblique tendon is used for the manual evaluation of the looseness or tightness of the tendon. Because of the subjective nature of this test, knowledge of other clinical findings may lead to a bias in its interpretation. We studied interexaminer differences in the results of the test to assess the reliability of this traction test.

Examiner A examined all of the patients and collected all clinical findings, including the results of magnetic resonance imaging. Each of the nine noninformed examiners participated in one or more traction tests without prior information regarding the clinical findings of the patient. The traction tests were performed on 31 patients under general anesthesia. The examiners performed the traction test alternately with examiner A and evaluated the laxity and tightness in the tendon based on a nine-step scale (-4 to +4). The results were recorded in a masked manner, and later a comparison between the evaluation results of examiner A and those of the other examiners was made.

Examiner A and the other examiners were in agreement within one grading step on 27 of the 31 (87.1%) traction tests.

We demonstrated that the interexaminer differences in the interpretations of the traction test were acceptable, and that after the noninformed examiners had performed the test several times, their interpretations became closer to those of examiner A.