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Biomechanical evaluation of physical examination tests for rotator cuff tears: a computer simulation study
Johanna Menze1, J Tomás Rojas2, Matthias A Zumstein3
1Faculty of Medicine, School of Precision and Biomedical Engineering, University of Bern, Bern, Switzerland; Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
Journal of Shoulder and Elbow Surgery
|December 15, 2024
Summary
The Lift-off test is more sensitive for subscapularis tears, and the Hornblower test is better for teres minor tears. Jobe and Full-can tests show low sensitivity for superior rotator cuff tears.
Area of Science:
- Orthopedics
- Biomechanics
- Sports Medicine
Background:
- Diagnostic shoulder tests for rotator cuff tears have variable reported sensitivities and specificities.
- Identifying biomechanically sensitive diagnostic postures and compensation mechanisms is crucial for accurate diagnosis.
Purpose of the Study:
- To identify diagnostic shoulder postures that are biomechanically most sensitive for detecting rotator cuff lesions.
- To analyze compensation mechanisms during specific diagnostic tests.
Main Methods:
- A musculoskeletal modeling study compared muscle activity in healthy and pathological shoulder models (anterior, superior, posterosuperior rotator cuff tears).
- Evaluated muscle moment arms and synergism for Lift-off, Bear Hug, Jobe, Full-can, Infraspinatus, and Hornblower tests.
Main Results:
- Lift-off test showed higher subscapularis activity than Bear Hug test in healthy models.
- Hornblower test demonstrated significantly higher teres minor and infraspinatus activity compared to the Infraspinatus test.
- Jobe and Full-can tests exhibited low synergistic activity increase in superior cuff tests.
Conclusions:
- The Lift-off test is more sensitive for subscapularis tears.
- The Hornblower test is more effective for assessing teres minor integrity in posterosuperior tears.
- Jobe and Full-can tests have low biomechanical sensitivity for superior rotator cuff tears.
