Accuracy of physical examination in subacromial impingement syndrome.
OBJECTIVE
Shoulder pain is a common complaint, frequently caused by subacromial impingement syndrome (SIS). There are a number of physical examination (PE) manoeuvres that explore the subacromial space. MRI provides an accurate anatomic image of the subacromial space, being the current gold standard in the diagnosis of SIS. The aim of this study is to evaluate the accuracy of the PE in the diagnosis of SIS and/or subacromial-subdeltoid bursitis (SSB) confirmed by MRI.


METHODS
Consecutive outpatients with an episode of shoulder pain were prospectively included in the study. They were examined by a rheumatologist and, within 3 days, an MRI was done. Sensitivity, specificity, positive and negative predictive values, and accuracy of PE manoeuvres were calculated using a 2 x 2 table.


RESULTS
Fourteen males and 16 females were included. All the tests exhibited acceptable sensitivity. As a result Yocum manoeuvre was considered the most sensitive and most accurate for SIS. With regard to SSB, the Gerber test was the most sensitive. The majority of the PE manoeuvres showed low specificity.


CONCLUSIONS
Most PE manoeuvres identify reasonably well subacromial impingement of the shoulder, although, in general, they have low specificity. The Yocum test has the best sensitivity and precision. Our data suggest that imaging techniques should be recommended to better define shoulder lesions.
Silva
L
L
Department of Rheumatology, Hospital Universitario Puerta de Hierro, San Martín de Porres 4, Madrid 28035, Spain.
Andréu
J L
JL
Muñoz
P
P
Pastrana
M
M
Millán
I
I
Sanz
J
J
Barbadillo
C
C
Fernández-Castro
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis*; D012785:Shoulder Joint / Q000473:pathology