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The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study
Nitin B Jain1, Jennifer Luz, Laurence D Higgins
1From the Department of Physical Medicine and Rehabilitation and Orthopaedics, Vanderbilt University School of Medicine, Nashville, Tennessee (NBJ); Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston (LDH, YD, EM, JNK); Departments of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown (JL); and Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School (JNK), and Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School (JJPW), Boston, Massachusetts.
Objective:
The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears.
Design:
From February 2011 to December 2012, 208 participants with shoulder pain were recruited in a cohort study.
Results:
Among tests for supraspinatus tears, Jobe test had a sensitivity of 88% (95% confidence interval [CI], 80%-96%), specificity of 62% (95% CI, 53%-71%), and likelihood ratio of 2.30 (95% CI, 1.79-2.95). The full can test had a sensitivity of 70% (95% CI, 59%-82%) and a specificity of 81% (95% CI, 74%-88%). Among tests for infraspinatus tears, external rotation lag signs at 0 degrees had a specificity of 98% (95% CI, 96%-100%) and a likelihood ratio of 6.06 (95% CI, 1.30-28.33), and the Hornblower sign had a specificity of 96% (95% CI, 93%-100%) and likelihood ratio of 4.81 (95% CI, 1.60-14.49).
Conclusions:
Jobe test and full can test had high sensitivity and specificity for supraspinatus tears, and Hornblower sign performed well for infraspinatus tears. In general, special tests described for subscapularis tears have high specificity but low sensitivity. These data can be used in clinical practice to diagnose rotator cuff tears and may reduce the reliance on expensive imaging.
