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Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions

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Abstract

Limited evidence exists regarding the validity of clinical examination for the detection of shoulder pathology. We therefore wished to establish the sensitivity, specificity, positive predictive value and negative predictive value of clinical tests and magnetic resonance imaging (MRI) in the diagnosis of rotator cuff disorders against findings at arthroscopy. Using recognised tests for specific shoulder lesions, 117 patients with shoulder symptoms awaiting surgery were examined in a standard manner. The diagnoses were categorised and compared with abnormalities found on MRI and at surgery. Results were cross-tabulated to determine the above parameters. Ninety-four patients formed the study group with a mean age of 51 years. The median duration of symptoms was 45 weeks. For clinical examination, sensitivity and specificity to detect a tear or rupture of supraspinatus were 30 % (16/54) and 38 % (15/40) and, for the detection of any pathology, were 94 % (67/71) and 22 % (5/23), respectively, compared with arthroscopy. Correspondingly, the sensitivity of MRI compared with arthroscopy to detect a tear or rupture of supraspinatus was 90 % (28/31) with a specificity of 70 % (46/53), whereas for the detection of any abnormality, the sensitivity was 92 % (65/71) with a specificity of 48 % (11/23). The sensitivity of detecting any rotator cuff abnormality is high when examination and MRI is compared with arthroscopy with the specificity being greater with MRI than examination. In patients with shoulder symptoms severe enough to consider surgery, clinical assessment followed by specific imaging may help define the pathology in order to direct appropriate management.

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Acknowledgments

The study was funded by the Cambridge Arthritis Research Endeavour.

Disclosures

None.

Ethics approval

The study was conducted with the approval of the hospitals’ local ethics committee.

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Authors and Affiliations

  1. Department of Rheumatology and Rheumatology Clinical Research Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Andrew J. K. Östör & Brian L. Hazleman

  2. Faculty of Health & Social Care, The Open University, Milton Keynes, UK

    Christine A. Richards

  3. Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Graham Tytherleigh-Strong

  4. Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Philip W. Bearcroft

  5. Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK

    A. Toby Prevost

  6. Spire Cambridge Lea Hospital, Cambridge, UK

    Cathy A. Speed

  7. School of Clinical Medicine, University of Cambridge, Cambridge, UK

    Andrew J. K. Östör

  8. Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 194, Hills Rd, Cambridge, CB2 0QQ, UK

    Andrew J. K. Östör

Authors
  1. Andrew J. K. Östör
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  2. Christine A. Richards
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  3. Graham Tytherleigh-Strong
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  4. Philip W. Bearcroft
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  5. A. Toby Prevost
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  6. Cathy A. Speed
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  7. Brian L. Hazleman
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Corresponding author

Correspondence to Andrew J. K. Östör.

Additional information

Key messages

• Clinical assessment has poor specificity when assessing shoulder pain, thus challenging the validity of standard tests for rotator cuff pathology.

• MRI has higher sensitivity and specificity than clinical examination when compared with arthroscopy as the gold standard.

• Examination followed by MRI is suggested in recalcitrant rotator cuff disease to guide management decisions.

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Östör, A.J.K., Richards, C.A., Tytherleigh-Strong, G. et al. Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions. Clin Rheumatol 32, 1283–1291 (2013). https://doi.org/10.1007/s10067-013-2260-0

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  • DOI: https://doi.org/10.1007/s10067-013-2260-0

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