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The limited diagnostic value of "feeling a pop" for identifying acute tendon rupture in workers' compensation
Sina Ramtin1, Prakash Jayakumar1, David Ring2
1Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA.
Background:
When an adult with rotator cuff tendinopathy reports feeling or hearing a pop along with new pain, both the clinician and the patient may inaccurately and unhelpfully expect (framing heuristic) an injury and consider it a compensable work claim.
Methods:
We retrospectively reviewed medical records of 118 people that filed work claims for new shoulder pain where aspects of their care or recovery trajectory triggered a peer review. We collected data on age, sex, reports of hearing or feeling a pop (25%; 29 of 118 patients), and reports of new numbness or tingling (11%; 13 of 118 patients). Five (4%) patients had a possible acute rotator cuff rupture (relatively large defect with good muscle) and 11 (9%) had a long head of biceps rupture, age indeterminate.
Results:
Accounting for confounding variables using logistic regression, possibly acute rotator cuff defects and age-indeterminate long head of biceps ruptures were associated with older age (odds ratio [OR], 1.10; 95% CI, 1.02-1.18) and the presence of a degenerative rotator cuff defect (OR, 6.0; 95% CI, 1.5-24) but not with sensation of a "pop."
Conclusions:
Based on this evidence, among people claiming injury at work, when a "pop" is reported the clinician should not expect new pathophysiology. Level of evidence: III.
