Rotator cuff crepitus: could Codman really feel a cuff tear?
BACKGROUND
The objective of this study was to assess the accuracy of palpating crepitus to diagnose rotator cuff tears.


METHODS
Seventy consecutive consenting patients who presented with shoulder pain and no previous imaging or surgery on the affected shoulder were prospectively enrolled during a 10-month period. A standardized patient history and examination, including the crepitus test, were recorded in addition to obtaining standard radiographs. Additional imaging after initial evaluation was performed with magnetic resonance imaging and interpreted by a musculoskeletal radiologist blinded to the examination findings. Statistical analysis was used to determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the crepitus test in the clinical diagnosis of a rotator cuff tear.


RESULTS
Sixty-three patients had histories, examinations, and imaging studies available for analysis. The crepitus test had a sensitivity of 67%, specificity of 80%, PPV of 91%, and NPV of 43% for all types of rotator cuff tears. The sensitivity and specificity for full-thickness or high-grade partial tears was 82% and 73%, respectively; the PPV and NPV were 77% and 79%. Increasing age improved accuracy as the presence of crepitus in patients older than 55 years had a sensitivity of 76%, specificity of 100%, PPV of 100%, and NPV of 38%.


CONCLUSIONS
The crepitus test has a favorable sensitivity, specificity, PPV, and NPV to assess the integrity of the rotator cuff and may be a useful examination in the clinical diagnosis of a rotator cuff tear.
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA. Electronic address: bponce@uabmc.edu.
Brent A
BA
Ponce
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
Joseph A
JA
Kundukulam
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
Evan D
ED
Sheppard
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
Jason R
JR
Determann
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
Gerald
G
McGwin
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
Carl A
CA
Narducci
Division of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
Marshall J
MJ
Crowther
D000328:Adult; D000368:Aged; D001182:Arthroscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D017006:Rotator Cuff / Q000473:pathology; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012680:Sensitivity and Specificity; D020069:Shoulder Pain / Q000209:etiology / Q000473:pathology; D013708:Tendon Injuries / Q000175:diagnosis*
Rotator cuff tear; crepitus test; palpation; physical examination