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

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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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

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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.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Skånevård Sund, Region Skåne, Sweden

    Knut E. Aagaard, Jonas Hänninen & Karl Lunsjö

  2. Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden

    Knut E. Aagaard

  3. Trauma Group, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE

    Fikri M. Abu-Zidan

  4. Department of Surgery, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates

    Fikri M. Abu-Zidan

Authors
  1. Knut E. Aagaard
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  2. Jonas Hänninen
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  3. Fikri M. Abu-Zidan
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  4. Karl Lunsjö
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Corresponding author

Correspondence to Fikri M. Abu-Zidan.

Ethics declarations

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.

Appendix 1

Appendix 1

Specific clinical diagnostic tests performed by the physical therapists. All the tests were performed with the patient in a relaxed sitting position.

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Aagaard, K.E., Hänninen, J., Abu-Zidan, F.M. et al. Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears: a prospective study. Eur J Trauma Emerg Surg 44, 735–745 (2018). https://doi.org/10.1007/s00068-017-0883-6

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