Original Article
Diagnostic Value of Clinical Tests for Infraspinatus Tendon Tears

https://doi.org/10.1016/j.arthro.2018.12.003Get rights and content

Purpose

To analyze and compare the diagnostic value and interpretation of 6 established clinical tests for infraspinatus tendon tears; to assess their ability to distinguish between partial- and full-thickness tears of the infraspinatus tendon; and to investigate whether conducting multiple tests increases the precision of diagnosis.

Methods

A total of 91 patients scheduled for shoulder arthroscopy from March 2015 to April 2017 were included in the present study. To assess the sensitivity, specificity, positive and negative predictive values, accuracy, diagnostic odds ratio, positive and negative likelihood ratios, and the area under the curve (AUC), intraoperative findings were compared with the results of 6 established clinical infraspinatus tests: the hornblower's test, the drop sign, the Patte sign, the external rotation lag sign (ERLS), the resisted external rotation test (RERT), and the infraspinatus scapular retraction test.

Results

A significant correlation was found between the results of the drop sign (P = .02), the ERLS (P = .02), and the RERT (P = .02) and the intraoperative findings. The RERT achieved the highest AUC (0.673). Assessing muscle weakness led to the highest diagnostic precision on the RERT (AUC = 0.673) as compared with pain (AUC = 0.528) or using both criteria (AUC = 0.655). No single clinical test was found to be useful in distinguishing between partial- and full-thickness tears. The combination of at least 2 or more tests improved the diagnostic precision significantly (P ≤ .007). The combination of the RERT and the Patte sign showed the best AUC (0.681) and highest correlation with the intraoperative findings (P = .023).

Conclusions

The results of the present study indicate that out of all the clinical tests investigated, the drop sign and the RERT were in isolation able to accurately diagnose tears of the infraspinatus tendon. Only muscle weakness should be considered when interpreting the RERT because of its greater AUC values and correlation with the arthroscopic findings. The present study also showed that the analyzed tests are not capable of distinguishing between partial- and full-thickness tears of the infraspinatus tendon and that the combination of at least 2 tests improved the diagnostic value. The combination of the RERT and the Patte sign showed the best AUC and highest correlation with the intraoperative findings.

Level of Evidence

Level II, diagnostic study, prospective comparative study.

Section snippets

Patient Recruitment

A total of 115 consecutive patients who presented with shoulder pain and were scheduled for shoulder arthroscopy from March 2015 to April 2017 were prospectively enrolled in the study. The inclusion criterion was that a shoulder arthroscopy was scheduled. Patients with the following characteristics were excluded from the study: (1) shoulder instability, (2) adhesive capsulitis, (3) calcifying tendinitis, or (4) any history of previous shoulder surgery including rotator cuff repair. Twenty-four

Results

A total of 19 full-thickness tears, 8 partial tears, and 64 intact infraspinatus tendons were encountered. Concomitant pathologies are presented in Table 2. Stratification of the results with concomitant shoulder's diseases is reported in Table 3.

The analysis of the diagnostic value of the performed tests showed that the drop sign (P = .02), the RERT (P = .02), and the ERLS (P = .02) correlated significantly with the intraoperative findings. Considering the AUC, the RERT (0.673) and the drop

Discussion

The most important finding of the present study was that the drop sign and RERT in isolation had a significant correlation with the intraoperative findings. The RERT showed better diagnostic precision and a greater correlation with the intraoperative findings than the drop sign. Furthermore, for the RERT, muscle weakness was found to possess the highest potential as an interpreting criterion as compared with pain or either pain and/or weakness. The results of the current study also demonstrate

Conclusions

The results of the present study indicate that out of all the clinical tests investigated, the drop sign and the RERT were in isolation able to accurately diagnose tears of the infraspinatus tendon. Only muscle weakness should be considered when interpreting the RERT because of its greater AUC values and correlation with the arthroscopic findings. The present study also showed that the analyzed tests are not capable of distinguishing between partial- and full-thickness tears of the

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    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

    See commentary on page 1348

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