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Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears.

Methods

The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor.

Results

The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins–Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67–0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01–0.98), for the drop arm sign.

Conclusions

The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times.

Level of evidence

Level II

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Author information

Authors and Affiliations

  1. Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland

    Alexandre Lädermann, Timon Meynard & Mohamed Ibrahim

  2. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Alexandre Lädermann

  3. Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland

    Alexandre Lädermann

  4. Southern Oregon Orthopedics, Medford, OR, USA

    Patrick J. Denard

  5. Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA

    Patrick J. Denard

  6. Faculty of Medicine, University of Fayoum, Fayoum, Egypt

    Mohamed Ibrahim

  7. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Mo Saffarini

  8. Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France

    Philippe Collin

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  6. Philippe Collin
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Contributions

AL participated in conception, design and interpretation of data, and manuscript writing. TM participated in conception, design, analysis and interpretation of data, and manuscript editing. PJD participated in conception, search replication and manuscript revision. MI participated in conception, design, grey literature review and manuscript revision. MS participated in conception, design, data extraction, analysis and interpretation of data, and manuscript drafting. PC participated in conception, search replication and manuscript revision.

Corresponding author

Correspondence to Alexandre Lädermann.

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Conflict of interest

AL is a paid consultant for Wright, Arthrex and Medacta and received royalties from Wright. PC is a paid consultant for Arthrex and Wright and receives royalties from Wright. PJD is a paid consultant for Arthrex. TM, MS and MI declare that they have no competing interests.

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The study protocol including the search strategy was registered on PROSPERO (CRD42019137256).

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Lädermann, A., Meynard, T., Denard, P.J. et al. Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests. Knee Surg Sports Traumatol Arthrosc 29, 2118–2133 (2021). https://doi.org/10.1007/s00167-020-06136-9

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  • DOI: https://doi.org/10.1007/s00167-020-06136-9

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