title: The validity of 9 physical tests for full-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients.
abstract: OBJECTIVE
  This study was undertaken to validate the diagnostic values of 9 different physical tests in emergency department patients with primary anterior shoulder dislocation (PASD) to select the best screening test for full-thickness rotator cuff tear (FTRCT) after PASD.
  
  
  METHODS
  A prospective analysis of 49 consecutive patients with x-ray-confirmed PASD was performed. All patients were followed at an average of 6.9 days (ranged from 4 to 10 days) in the emergency department. On the day of follow-up, 9 physical tests (namely, Jobe test, external rotation lag sign test, infraspinatus muscle strength test, dropping test, drop test, liftoff test, internal rotation lag sign test, belly-press test, and belly-off test) followed by shoulder ultrasound scan were performed to detect FTRCT.
  
  
  RESULTS
  The prevalence of FTRCT after PASD is 37% (95% confidence interval [CI], 24%-52%). Fourteen percent of the patients with PASD were complicated with isolated supraspinatus tendon tear, whereas 22% were complicated with supraspinatus tendon tear combined with subscapularis and/or infraspinatus tendon tear. Jobe test has the highest sensitivity among the 9 physical tests being evaluated. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test, and likelihood ratio for negative test of Jobe test as a screening test for FTRCT after PASD are 89% (95% CI, 64%-98%), 55% (95% CI, 36%-72%), 53% (95% CI, 35%-71%), 89% (95% CI, 65%-98%), 1.97 (95% CI, 1.29-2.99), and 0.20 (95% CI, 0.05-0.79), respectively.
  
  
  CONCLUSIONS
  The prevalence of FTRCT after PASD is 37% (95% CI, 24%-52%). Jobe test has the highest sensitivity (89% CI, 64%-98%) among the tests.
authors.affiliation: Accident and Emergency Department, Ruttonjee Hospital, Hong Kong, SAR, China. yuenchikit@gmail.com
authors.forename: Chi Kit
authors.initials: CK
authors.lastname: Yuen
authors.forename: Ka Leung
authors.initials: KL
authors.lastname: Mok
authors.forename: Pui Gay
authors.initials: PG
authors.lastname: Kan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D017006:Rotator Cuff / Q000503:physiopathology; D000070636:Rotator Cuff Injuries; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult