title: Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder.
abstract: OBJECTIVE
  High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the findings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder.
  
  
  METHODS
  Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa.
  
  
  RESULTS
  In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86) whereas the Jobe supraspinatus test showed the highest specificity (0.55). To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specificity (0.72). The infraspinatus test showed a high sensitivity (0.90) and specificity (0.74). All AC tests (painful arc II(a), AC joint tenderness(b), cross body adduction stress test(c)) showed high specificities ((a)0.96, (b)0.99, (c)0.96). Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47) and the Yergason test the highest specificity (0.88).
  
  
  CONCLUSIONS
  Knowledge of sensitivity and specificity of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.
authors.affiliation: Faculty of Medicine, University of Zurich, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Micheroli
authors.affiliation: Department of Rheumatology, University Hospital of Basel, Switzerland.
authors.forename: Diego
authors.initials: D
authors.lastname: Kyburz
authors.affiliation: Department of Rheumatology, University Hospital of Zurich, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ciurea
authors.affiliation: Sonography Institute Glattpark, Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Dubs
authors.affiliation: Department of Rheumatology, University Hospital of Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Toniolo
authors.affiliation: Swiss Federal Institute of Technology, Zurich, Switzerland.
authors.forename: Samuel Pascal
authors.initials: SP
authors.lastname: Bisig
authors.affiliation: Ultrasound Center, Department of Rheumatology, Bethesda Hospital Basel, Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Tamborrini
keywords: diagnosis; pain; physical examination; shoulder; ultrasonography