Does physiotherapy diagnosis of shoulder pathology compare to arthroscopic findings?
OBJECTIVE
To explore the ability of a physiotherapist, using a standardised musculoskeletal physiotherapy assessment protocol, to accurately identify the structures potentially responsible for shoulder symptoms against a standardised arthroscopic shoulder diagnostic assessment, and to determine the physiotherapists' ability to influence post-test diagnostic accuracy.


METHODS
Consecutive case-based cohort study.


METHODS
All participants were selected by two orthopaedic surgeons for arthroscopic investigation during a 6-month period.


METHODS
Private orthopaedic clinic.


METHODS
All consenting participants selected for arthroscopic investigation were examined by the physiotherapist prior to arthroscopy. Presence and priority of impairments/diagnoses were recorded on a standardised form. Inter and intra-rater reliability and diagnostic accuracy were tabulated.


METHODS
Proportional agreement on diagnostic incidence (broad) and priority (strict) using 2×2 contingency tables for sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratios were calculated. Post-test probabilities were analysed to determine the influence of a positive or a negative finding.


RESULTS
211 participants, aged 14-79 years were included. Overall prevalence of subacromial pathology was (77%) and, disorders of the passive restraints (29%). For both negative and positive findings, post-test probabilities were not notably altered; although positive findings yielded greater value in the decision-making modelling. The physiotherapist's ability to identify individual pathology (eg, tendon rupture vs tendinopathy, capsular vs labral) was lower than recognition of pathology within the broader diagnostic category.


CONCLUSIONS
The physiotherapist's ability to diagnose individual pathologies was inconsistent. Indirectly, this raises the issue of whether signs and symptoms identified under arthroscopic surgery are reflective of a lesion/pathology reflective of a specific tissue.
School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Mary Elizabeth
ME
Magarey
School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Mark Alan
MA
Jones
Division of Physical Therapy, Department of Orthopedics, Duke University, Durham, North Carolina, USA.
Chad E
CE
Cook
Orthopaedic Division, Sportsmed·SA, Adelaide, South Australia, Australia.
Michael George
MG
Hayes
D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries / Q000175:diagnosis*; D012785:Shoulder Joint / Q000503:physiopathology*; D052256:Tendinopathy / Q000175:diagnosis; D013708:Tendon Injuries / Q000175:diagnosis; D055815:Young Adult
Evaluation; Physiotherapy