title: Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care.
abstract: OBJECTIVE
  Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort.
  
  
  METHODS
  Participants were consecutively recruited from primary health care practices (n = 203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P<0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated.
  
  
  RESULTS
  A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86-1.00; negative likelihood ratio: 0.00, 95% CI: 0.00-0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86-0.95; positive likelihood ratio 4.66, 95% CI: 2.34-8.74).
  
  
  CONCLUSIONS
  Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation.
authors.affiliation: Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
authors.forename: Angela
authors.initials: A
authors.lastname: Cadogan
authors.affiliation: Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: McNair
authors.affiliation: School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand ; Physiosouth, Christchurch, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Laslett
authors.affiliation: Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand ; School of Health Sciences, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Hing
authors.affiliation: School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Taylor
keywords: Physical examination; Primary health care; Rotator cuff; Sensitivity; Specificity