title: Utility of features of the patient's history in the diagnosis of atraumatic shoulder pain: a systematic review.
abstract: BACKGROUND
  Whereas physical examination tests for shoulder disorders have numeric values that describe the utility of the test and its effect on the probability of having a diagnosis, this information is lacking for elements of the history. The purpose of this study was to conduct a systematic review of the literature to determine numeric data (sensitivity, specificity, predictive values, and likelihood or odds ratios) for elements of the history with regard to diagnoses in patients with chronic atraumatic shoulder pain.
  
  
  METHODS
  We performed a systematic review to extract information from the existing literature regarding the numeric utility of different features of the patient history as they pertain to chronic atraumatic shoulder pain. Data sources were MEDLINE through PubMed (1946-January 2012) and EMBASE through Ovid (1980-January 2012).
  
  
  RESULTS
  Twenty-one studies met inclusion criteria. A diagnosis of rotator cuff tear was more likely with a history of hypercholesterolemia, having a relative with rotator cuff disease, excessive lifting, above-shoulder work, hand-held vibration work, or age older than 60 years. Acromioclavicular arthritis was more likely in weightlifters. Glenohumeral arthritis was more likely if the patient has a history of prior dislocation, age >75 years, or a diagnosis of knee osteoarthritis. Adhesive capsulitis was more likely with a history of diabetes or thyroid disorder. Posterior labral tear was more likely in football players.
  
  
  CONCLUSIONS
  The numeric values for the utility of these history features will help establish numeric probabilities for diagnoses in patients with shoulder pain.
authors.affiliation: Vanderbilt Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Raynor
authors.affiliation: Vanderbilt Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: j.kuhn@vanderbilt.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Kuhn
mesh_terms: D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000175:diagnosis*; D008487:Medical History Taking; D010808:Physical Examination; D012785:Shoulder Joint; D020069:Shoulder Pain / Q000209:etiology*
keywords: Shoulder pain; diagnosis; history; likelihood ratios; predictive values; probability; sensitivity; specificity