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 supraspinatus and infraspinatus (one study with 37 patients and 46 shoulders; positive likelihood ratio = 7.2; 95% confidence interval [CI], 1.7 to 31). In this test, the elbow is flexed to 90 degrees, and the shoulder is externally rotated as far as possible. If the patient is unable to maintain that position, it is considered a positive result.
A positive internal rotation lag test was the best for detecting full-thickness tears of the subscapularis (one study with 37 patients and 46 shoulders; positive likelihood ratio = 5.6; 95% CI, 2.6 to 12). The internal rotation lag test was the most accurate of the strength tests when negative (one study with 37 patients and 46 shoulders; negative likelihood ratio = 0.04; 95% CI, 0.0 to 0.58). In this test, the elbow is flexed to 90 degrees, and the shoulder
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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