Article

OBJECTIVE: To investigate the reliability and diagnostic accuracy of individual
tests and combination of tests for subacromial impingement syndrome (SAIS).
DESIGN: A prospective, blinded study design. SETTING: Orthopedic surgeon shoulder
clinic. PARTICIPANTS: Patients with shoulder pain (n=55, mean age=40.6y).
INTERVENTIONS: Patients were evaluated with 5 physical examination tests for
SAIS: Neer, Hawkins-Kennedy, painful arc, empty can (Jobe), and external rotation
resistance tests. Surgical diagnosis was the reference standard. MAIN OUTCOME
MEASURES: Diagnostic accuracy calculated with a receiver operating characteristic
(ROC) curve and sensitivity, specificity, positive likelihood ratio (+LR), and
negative likelihood ratio (-LR). A forward stepwise binary logistic regression
analysis was used to determine the best test combination for SAIS. An ROC curve
analysis was also used to determine the cut point of the number of tests
discriminating between the presence and absence of SAIS. Kappa coefficients and
percent agreement assessed interrater reliability. RESULTS: The ROC analyses
revealed a significant area under the curve (AUC) (AUC=.67-.72, P<.05) for all
tests, except for the Hawkins-Kennedy. The tests with a +LR greater than or equal
to 2.0 were the painful arc (+LR=2.25; 95% CI, 1.33-3.81), empty can (+LR=3.90;
95% CI, 1.5-10.12), and the external rotation resistance tests (+LR=4.39; 95% CI,
1.74-11.07). Tests with -LR less than or equal to 0.50 were the painful arc
(-LR=.38; 95% CI, .16-.90), external rotation resistance (-LR=.50; 95% CI,
.28-.89), and Neer tests (-LR=.35; 95% CI, .12-.97). The regression analysis had
no specific test combinations for confirming or ruling out SAIS. The ROC analysis
was significant (AUC=.79, P=.001), with a cut point of 3 positive tests out of 5
tests. Reliability was moderate to substantial agreement (kappa=.45-.67) for the
painful arc, empty can, and external rotation resistance tests and fair strength
of agreement (kappa=.39-.40) for the Neer and Hawkins-Kennedy tests. CONCLUSIONS:
The single tests of painful arc, external rotation resistance, and Neer are
useful screening tests to rule out SAIS. The single tests of painful arc,
external rotation resistance, and empty can are helpful to confirm SAIS. The
reliability of all tests was acceptable for clinical use. Based on reliability
and diagnostic accuracy, the single tests of the painful arc, external rotation
resistance, and empty can have the best overall clinical utility. The cut point
of 3 or more positive of 5 tests can confirm the diagnosis of SAIS, while less
than 3 positive of 5 rules out SAIS.

Langue : ANGLAIS