Correlation between clinical diagnosis and arthroscopic findings of the shoulder

To assess the accuracy of clinical examination by non-specialist orthopaedic surgeons of patients presenting to a diagnostic and treatment centre (DTC) for arthroscopic shoulder surgery.

A retrospective review of notes of 130 consecutive shoulder arthroscopies performed at a DTC over a 10 month period. Preoperative clinical diagnosis was compared with operative arthroscopic findings. Additional information from preoperative imaging was compared with clinical examination and arthroscopic findings. Preoperative clinical examinations and consent were undertaken by clinical fellows, (SpR level) and non-upper limb consultant orthopaedic surgeons. Consultants specialising in upper limb surgery performed the operations.

Six main groups were identified on the basis of clinical examination: impingement 76 cases (58%), instability 22 cases (17%), frozen shoulder 11 cases (8%), rotator cuff tear four cases (3%), non-specific pain eight cases (6%), and normal clinical examination nine cases (7%). Impingement and instability diagnosed clinically strongly correlated with the arthroscopic findings. Clinical diagnosis of frozen shoulder and rotator cuff tears had a weaker correlation with the arthroscopic findings. Of the nine cases of normal clinical examination, abnormality was found at arthroscopy in all cases.

There have been very few studies comparing clinical examination of the shoulder with arthroscopic findings. This study emphasises the importance of good clinical examination skills in diagnosing common shoulder abnormalities. The addition of imaging, particularly ultrasound and magnetic resonance imaging further increases the likelihood of an accurate diagnosis. Shoulder examination should be taught with as much emphasis at both undergraduate and postgraduate level as other orthopaedic clinical examinations.