title: Preliminary development of a clinical prediction rule for treatment of patients with suspected SLAP tears.
abstract: OBJECTIVE
  To use the clinical prediction rule process to identify patient variables, measured on initial clinical presentation, that would be predictive of failure to achieve satisfactory improvement, while following a rehabilitation program, in the modification of SLAP injury symptoms and dysfunction.
  
  
  METHODS
  A cohort of patients received the clinical diagnosis of a SLAP lesion based on specific history and examination findings and/or magnetic resonance imaging. They underwent a physical examination of the kinetic chain and shoulder, including tests for labral injury. Patients followed a standardized physical therapy program emphasizing restoration of demonstrated strength, flexibility, and strength-balance deficits. At 6 weeks' follow-up, patients were re-evaluated and divided into those recommended for surgery (RS) and those not recommended for surgery (NRS). Bivariate logistic regression was performed to identify the best combination of predictive factors.
  
  
  RESULTS
  Fifty-eight patients (aged 39 ± 11 years, 45 men) were included. Of these, 31 (53%) were categorized as NRS and 27 (47%) as RS. The presence of a painful arc of motion (odds ratio, 3.95; P = .024) and the presence of increased forward scapular posture (odds ratio, 1.27; P = .094) on the injured side were predictive of being in the RS group. This finding indicates that the odds of being in the RS group increased 4 times when a positive painful arc was present and increased 27% with every 1-cm increase in involved anterior shoulder posture.
  
  
  CONCLUSIONS
  A structured rehabilitation program resulted in modification of symptoms and improved function at 6 weeks' follow-up in over half of patients in the study group. On initial evaluation, the presence of a painful arc of overhead motion, indicating loss of normal glenohumeral kinematics, and the presence of forward shoulder posture, indicating an altered scapular position, represent negative predictive factors for success of rehabilitation. Future validation of the model in a larger population is necessary.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Kinesiology, California State University, Fresno, California, U.S.A.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Moore-Reed
authors.affiliation: Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: W Ben
authors.initials: WB
authors.lastname: Kibler
authors.affiliation: Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.; Division of Athletic Training, University of Kentucky, Lexington, Kentucky, U.S.A.. Electronic address: ascia@lexclin.com.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Sciascia
authors.affiliation: Division of Athletic Training, University of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Tim
authors.initials: T
authors.lastname: Uhl
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery; D000070599:Shoulder Injuries; D055815:Young Adult