Advertisement

European Journal of Trauma and Emergency Surgery

, Volume 44, Issue 5, pp 735–745 | Cite as

Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears: a prospective study

  • Knut E. Aagaard
  • Jonas Hänninen
  • Fikri M. Abu-Zidan
  • Karl Lunsjö
Original Article
  • 234 Downloads

Abstract

Background

Early diagnosis of traumatic acute full-thickness rotator cuff tears (FTRCT) is important to offer early surgical repair. Late repairs following fatty infiltration of the rotator cuff muscles have less favorable results. We think that physical therapists are valuable diagnosticians in a screening process. The objective of this study was to evaluate the usefulness of physical therapists as first-line diagnosticians in detecting acute traumatic FTRCT.

Methods

Between November 2010 and January 2014, 394 consecutive patients having an age between 18 and 75 years who sought medical care because of acute shoulder trauma with acute onset of pain, limited abduction and negative plain radiographs were included in the study. A clinical assessment was conducted by a physical therapist 1 week after the trauma. The patients were divided into three groups by the physical therapist according to the findings: FTRCT (Group I, n = 122); sprain (Group II, n = 62); or other specific diagnoses (Group III, n = 210). Group III patients were discharged and excluded from the study. Magnetic Resonance Imaging shoulder was performed for all Group I patients and for all patients with persistent symptoms in Group II.

Results

79/184 patients had FTRCTs documented by MRI in groups I and II. The clinical assessment of the physical therapist had a sensitivity of 85%, specificity of 68%, and usefulness index of 0.45 (> 0.35 considered useful) for diagnosing FTRCT.

Conclusion

Physical therapists can be useful as first-line diagnosticians in detecting traumatic FTRCT.

Keywords

Rotator cuff tear Physical therapist Usefulness index Shoulder injury Physical examination 

Abbreviations

ASAP

Acute Shoulder Assessment Project

CI

Confidence interval

FN

False negative

FP

False positive

EP

Emergency physician

ER

Emergency room

FTRCT

Full-thickness rotator cuff tears

GP

General practitioner

MRI

Magnetic resonance imaging

NEX

Number of excitations

NKO

The Swedish National Musculoskeletal Competence Center

FOV

Field of view

TSE

Turbo spin echo

STIR

Short tau inversion recovery

TN

True negative

TP

True positive

Notes

Acknowledgements

The authors thank the physical therapists Anna Lönnberg and Madelaine Andersson for their clinical examination and monitoring the study and Dr. Torsten Boegård for MRI reviews and radiological advice.

Compliance with ethical standards

Conflict of interest

Knut E Aagaard, Jonas Hänninen, Fikri Abu-Zidan, and Karl Lunsjo declare that they have no conflict of interest.

Research involving human participant

The study was approved by the regional Ethical review Board in Lund, Sweden, 2011 (Registration Number 2011/119) and met the standards outlined in the Declaration of Helsinki.

Informed consent

An informed consent was taken from all patients who have participated in this study.

Funding

This study was supported by grants from the Stig och Ragna Gorthon Foundation, Helsingborg, Sweden.

References

  1. 1.
    Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? Br J Sports Med. 2009;43:259–64.CrossRefGoogle Scholar
  2. 2.
    Reilingh ML, Kuijpers T, Tanja-Harfterkamp AM, van der Windt DA. Course and prognosis of shoulder symptoms in general practice. Rheumatology. 2008;47:724–30.CrossRefGoogle Scholar
  3. 3.
    Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Rel Res. 2007;455:52–63.CrossRefGoogle Scholar
  4. 4.
    Mall NA, Lee AS, Chahal J, et al. An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy. 2013;29:366–76.CrossRefGoogle Scholar
  5. 5.
    Bjornsson HC, Norlin R, Johansson K, Adolfsson LE. The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears: structural and clinical outcomes after repair of 42 shoulders. Acta Orthop. 2011;82:187–92.CrossRefGoogle Scholar
  6. 6.
    Mukovozov I, Byun S, Farrokhyar F, Wong I. Time to surgery in acute rotator cufftear: A systematic review. Bone Joint Res. 2013;2:122–8.CrossRefGoogle Scholar
  7. 7.
    Sorensen AK, Bak K, Krarup AL, et al. Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg. 2007;16:174–80.CrossRefGoogle Scholar
  8. 8.
    Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess (Winchester England). 2003;7(iii):1–166.Google Scholar
  9. 9.
    Bak K, Sorensen AK, Jorgensen U, et al. The value of clinical tests in acute full-thickness tears of the supraspinatus tendon: does a subacromial lidocaine injection help in the clinical diagnosis? A prospective study. Arthroscopy. 2010;26:734–42.CrossRefGoogle Scholar
  10. 10.
    Goutallier D, Postel JM, Lavau L, Bernageau J. Impact of fatty degeneration of the suparspinatus and infraspinatus muscles on the prognosis of surgical repair of the rotator cuff. Revue De Chirurgie Orthopedique Et Reparatrice De L’appareil Moteur. 1999;85:668–76.PubMedGoogle Scholar
  11. 11.
    Bassett RW, Cofield RH. Acute tears of the rotator cuff. The timing of surgical repair. Clin Orthop Relat Res. 1983;175:18–24.Google Scholar
  12. 12.
    Hantes ME, Karidakis GK, Vlychou M, Varitimidis S, Dailiana Z, Malizos KN. A comparison of early versus delayed repair of traumatic rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2011;19:1766–70.CrossRefGoogle Scholar
  13. 13.
    Nationellt kompetenscentrum för ortopedi, Indikationer för behandling inom ortopedi, Nationella medicinska indikationer för axelkirurgi, Lund 2006, Version 1.1. http://rcsyd.se/wp-content/uploads/2014/12/axel1.pdf. Accessed 25 Jan 2017.
  14. 14.
    Antonopoulou MD, Alegakis AK, Hadjipavlou AG, Lionis CD. Studying the association between musculoskeletal disorders, quality of life and mental health. A primary care pilot study in rural Crete, Greece. BMC Musculoskel Dis. 2009;10:143.CrossRefGoogle Scholar
  15. 15.
    Razmjou H, Robarts S, Kennedy D, McKnight C, Macleod AM, Holtby R. Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: diagnostic agreement and effect on wait times. Physiother Can. 2013;65:46–55.CrossRefGoogle Scholar
  16. 16.
    Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP. Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am. 1991;73:17–29.CrossRefGoogle Scholar
  17. 17.
    Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997;344:275–83.CrossRefGoogle Scholar
  18. 18.
    Browner WSNT., Cummings SR. Designing a new study: III. Diagnostic tests. In: Hulley SB, Cummings SR, editors. Designing clinical Research: An epidemiologic approach. 1st ed. Baltimore: Williams and Wilkins; 1988. pp. 87–97.Google Scholar
  19. 19.
    Lavelle SM, Kanagaratnam B. The information value of clinical data. Int J Biomed Comput. 1990;26:203–9.CrossRefGoogle Scholar
  20. 20.
    Exact binomial and poisson confidence intervals. Diagnostic test evaluation calculator, the interactive statistical pages website. 2015. http://www.statpages.org/confint.html. Accessed 20th August 2015.
  21. 21.
    Hefny AF, Kunhivalappil FT, Matev N, Avila NA, Bashir MO, Abu-Zidan FM. Usefulness of free intraperitoneal air detected by CT scan in diagnosing bowel perforation in blunt trauma: Experience from a community-based hospital. Injury. 2015;46:100–4.CrossRefGoogle Scholar
  22. 22.
    Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Diagnosis and screening. In: Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB, editors. Evidence-based medicine: How to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000. pp. 67–93.Google Scholar
  23. 23.
    Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;24:9.Google Scholar
  24. 24.
    Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74:713–25.CrossRefGoogle Scholar
  25. 25.
    Mochizuki T, Sugaya H, Uomizu M, et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical technique. J Bone Joint Surg Am. 2009;91(Suppl 2 Pt 1):1–7.CrossRefGoogle Scholar
  26. 26.
    Beitzel K, Mazzocca AD, Bak K, et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the rockwood classification for acromioclavicular joint injuries. Arthroscopy. 2014;30:271–8.CrossRefGoogle Scholar
  27. 27.
    Cadogan A, McNair P, Laslett M, Hing W, Taylor S. Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care. J Man Manip Ther. 2013;21:148–59.CrossRefGoogle Scholar
  28. 28.
    Forbush SW, White DM, Smith W. The comparison of the empty can and full can techniques and a new diagonal horizontal adduction test for supraspinatus muscle testing using cross-sectional analysis through ultrasonography. Int J Sports Phys Ther. 2013;8:237–47.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Hughes PC, Green RA, Taylor NF. Isolation of infraspinatus in clinical test positions. J Sci Med Sport. 2014;17:256.CrossRefGoogle Scholar
  30. 30.
    Jain NB, Wilcox RB III, Katz JN, Higgins LD. Clinical review: teaching rounds: clinical examination of the rotator cuff. PM&R. 2013;5:45–56.CrossRefGoogle Scholar
  31. 31.
    O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–3.CrossRefGoogle Scholar
  32. 32.
    Yuen CK, Mok KL, Kan PG. The validity of 9 physical tests for full-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients. Am J Emerg Med. 2012;30:1522–9.CrossRefGoogle Scholar
  33. 33.
    Lin L, Yan H, Xiao J, Ao Y, Cui G. Internal rotation resistance test at abduction and external rotation: a new clinical test for diagnosing subscapularis lesions. Knee Surg Sports Traumatol Arthrosc. 2015;23:1247–52.CrossRefGoogle Scholar
  34. 34.
    Duncan NS, et al. Surgery within 6 months of an acute rotator cuff tear significantly improves outcome. J Shoulder Elbow Surg. 2015;24:1876–80.CrossRefGoogle Scholar
  35. 35.
    Petersen SA, Murphy TP. The timing of rotator cuff repair for the restoration of function. J Shoulder Elbow Surg. 2011;1:62–8.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Knut E. Aagaard
    • 1
    • 2
  • Jonas Hänninen
    • 1
  • Fikri M. Abu-Zidan
    • 3
    • 4
  • Karl Lunsjö
    • 1
  1. 1.Department of OrthopedicsSkånevård SundRegion SkåneSweden
  2. 2.Orthopedics, Department of Clinical Sciences LundLund UniversityLundSweden
  3. 3.Trauma Group, College of Medicine and Health SciencesUAE UniversityAl-AinUAE
  4. 4.Department of Surgery, College of Medicine and Health SciencesUAE UniversityAl AinUnited Arab Emirates

Personalised recommendations