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Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review.

Publication ,  Journal Article
Hermans, J; Luime, JJ; Meuffels, DE; Reijman, M; Simel, DL; Bierma-Zeinstra, SMA
Published in: JAMA
August 28, 2013

IMPORTANCE: Rotator cuff disease (RCD) is the most common cause of shoulder pain seen by physicians. OBJECTIVE: To perform a meta-analysis to identify the most accurate clinical examination findings for RCD. DATA SOURCES: Structured search in MEDLINE, EMBASE, and CINAHL from their inception through May 2013. STUDY SELECTION: For inclusion, a study must have met the following criteria: (1) description of history taking, physical examination, or clinical tests concerning RCD; (2) detailing of sensitivity and specificity; (3) use of a reference standard with diagnostic criteria prespecified; (4) presentation of original data, or original data could be obtained from the authors; and (5) publication in a language mastered by one of the authors (Danish, Dutch, English, French, German, Norwegian, Spanish, Swedish). MAIN OUTCOMES AND MEASURES: Likelihood ratios (LRs) of symptoms and signs of RCD or of a tear, compared with an acceptable reference standard; quality scores assigned using the Rational Clinical Examination score and bias evaluated with the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS: Twenty-eight studies assessed the examination of referred patients by specialists. Only 5 studies reached Rational Clinical Examination quality scores of level 1-2. The studies with quality scores of level 1-2 included 30 to 203 shoulders with the prevalence of RCD ranging from 33% to 81%. Among pain provocation tests, a positive painful arc test result was the only finding with a positive LR greater than 2.0 for RCD (3.7 [95% CI, 1.9-7.0]), and a normal painful arc test result had the lowest negative LR (0.36 [95% CI, 0.23-0.54]). Among strength tests, a positive external rotation lag test (LR, 7.2 [95% CI, 1.7-31]) and internal rotation lag test (LR, 5.6 [95% CI, 2.6-12]) were the most accurate findings for full-thickness tears. A positive drop arm test result (LR, 3.3 [95% CI, 1.0-11]) might help identify patients with RCD. A normal internal rotation lag test result was most accurate for identifying patients without a full-thickness tear (LR, 0.04 [95% CI, 0.0-0.58]). CONCLUSIONS AND RELEVANCE: Because specialists performed all the clinical maneuvers for RCD in each of the included studies with no finding evaluated in more than 3 studies, the generalizability of the results to a nonreferred population is unknown. A positive painful arc test result and a positive external rotation resistance test result were the most accurate findings for detecting RCD, whereas the presence of a positive lag test (external or internal rotation) result was most accurate for diagnosis of a full-thickness rotator cuff tear.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

August 28, 2013

Volume

310

Issue

8

Start / End Page

837 / 847

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • Shoulder Pain
  • Rotator Cuff Injuries
  • Referral and Consultation
  • Reference Values
  • Physical Examination
  • Medical History Taking
  • Humans
  • General & Internal Medicine
  • 42 Health sciences
 

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Hermans, J., Luime, J. J., Meuffels, D. E., Reijman, M., Simel, D. L., & Bierma-Zeinstra, S. M. A. (2013). Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA, 310(8), 837–847. https://doi.org/10.1001/jama.2013.276187
Hermans, Job, Jolanda J. Luime, Duncan E. Meuffels, Max Reijman, David L. Simel, and Sita M. A. Bierma-Zeinstra. “Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review.JAMA 310, no. 8 (August 28, 2013): 837–47. https://doi.org/10.1001/jama.2013.276187.
Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SMA. Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA. 2013 Aug 28;310(8):837–47.
Hermans, Job, et al. “Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review.JAMA, vol. 310, no. 8, Aug. 2013, pp. 837–47. Pubmed, doi:10.1001/jama.2013.276187.
Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SMA. Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA. 2013 Aug 28;310(8):837–847.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

August 28, 2013

Volume

310

Issue

8

Start / End Page

837 / 847

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • Shoulder Pain
  • Rotator Cuff Injuries
  • Referral and Consultation
  • Reference Values
  • Physical Examination
  • Medical History Taking
  • Humans
  • General & Internal Medicine
  • 42 Health sciences