Article

OBJECTIVE: To determine the diagnostic accuracy of commonly used physical tests
for subacromial impingement syndrome, using ultrasound as the reference standard.
DESIGN: A cross-sectional study of 59 participants with chronic shoulder pain of
more than four months duration with a referral for diagnostic ultrasound scanning
were invited to participate in the study. MAIN MEASURES:
Thirty-four participants
met the inclusion criteria and had an ultrasound scan followed immediately by
application of the following tests: Neer's sign, Hawkins and Kennedy test,
painful arc of abduction, empty and full can tests, resisted isometric shoulder
abduction and resisted isometric shoulder external rotation. Using the two-way
contingency table method sensitivity, specificity, likelihood ratios and overall
accuracy were calculated for each physical test. RESULTS: Diagnostic values for
each test varied considerably. The Hawkins and Kennedy test was the most accurate
test for diagnosing any degree of subacromial impingement syndrome (71.0%). The
most accurate tests for diagnosing subcategories of impingement were pain on
resisted external rotation and weakness during the full can test (63.6%) for
presence of subdeltoid fluid, pain on resisted external rotation (58.8%) for
partial thickness tears and the painful arc test (62.1%) for full thickness
tears. CONCLUSIONS: As the predictive values of these tests are shown to be
variable in this study it indicates that the clinical tests identified have
limited use in informing diagnosis. Emphasis on the management of dysfunction may
be more appropriate rather than reliance on clinical tests with inconclusive
sensitivity and specificity if ultrasound scanning is not available.

Langue : ANGLAIS