FPIN's Help Desk Answers
Rotator Cuff Disease: Diagnostic Tests
Am Fam Physician. 2016 Dec 1;94(11):925-926.
Which physical examination tests are best for diagnosing rotator cuff disease in patients with shoulder pain?
A positive lag sign with external rotation is the best test for full-thickness tears of the infraspinatus and supraspinatus (positive likelihood ratio = 7.2). A positive lag sign with internal rotation is best for assessing full-thickness tears of the subscapularis (positive likelihood ratio = 5.6). (Strength of Recommendation = B, based on diagnostic cohort studies.)
A meta-analysis of five diagnostic cohort studies (432 men and women, 442 shoulders) evaluated physical examination tests for rotator cuff disease.1 Patients had a mean age of 44 to 58 years and a presenting symptom of shoulder pain; exclusion criteria included a history of neck or shoulder trauma. The prevalence of rotator cuff disease ranged from 33% to 81%, depending on the study. The diagnostic standard was ultrasonography or magnetic resonance imaging. Five strength tests used weakness as the response criterion for a positive result. A positive external rotation lag test was the most accurate strength test for identifying full-thickness tears of the
1. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SM. Does this patient with shoulder pain have rotator cuff disease? The rational clinical examination systematic review. JAMA. 2013;310(8):837–847.
2. Lasbleiz S, Quintero N, Ea K, et al. Diagnostic value of clinical tests for degenerative rotator cuff disease in medical practice. Ann Phys Rehabil Med. 2014;57(4):228–243.
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