Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review

Area of Science:

• Orthopedics
• Diagnostic Accuracy
• Musculoskeletal Research

Background:

• Rotator cuff pathology is a common cause of shoulder pain.
• Accurate diagnosis is crucial for effective treatment planning.
• The reliability of clinical tests for diagnosing rotator cuff pathology remains a concern.

Purpose of the Study:

• To systematically review the diagnostic accuracy of clinical tests used for rotator cuff pathology.
• To evaluate the effectiveness of various clinical tests in identifying rotator cuff tears.

Main Methods:

• A systematic review of 13 studies evaluating the diagnostic accuracy of clinical tests for rotator cuff pathology.
• Analysis of 89 separate evaluations of diagnostic accuracy using likelihood ratios.
• Inclusion of studies involving patients with shoulder pain undergoing clinical testing.

Main Results:

• Only one test, palpation for supraspinatus ruptures, yielded significant positive and negative likelihood ratios.
• Eight out of 89 evaluations showed significant likelihood ratios, but these were not consistently found across studies.
• A substantial majority (80%) of clinical test evaluations did not provide significant diagnostic accuracy indicators.

Conclusions:

• Most clinical tests for rotator cuff pathology are inaccurate and not recommended for routine clinical use.
• Certain tests, like palpation, combined Hawkins/painful arc/infraspinatus, Napoleon, lift-off, belly-press, and drop-arm tests, may offer limited diagnostic suspicion when positive.
• Negative findings on palpation, empty can, or Hawkins-Kennedy tests may help reduce suspicion of a rotator cuff tear.