title: Intertester reliability of shoulder complaints diagnoses in primary health care.
abstract: OBJECTIVE
  Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Four primary health care clinicians used patients' history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints.
  
  
  METHODS
  62 patients, aged 18-75 years.
  
  
  METHODS
  Reliability of diagnoses was assessed by observed intertester agreement and Cohen's kappa. A total of 372 diagnostic pairs were available for intertester comparisons.
  
  
  RESULTS
  Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73).
  
  
  CONCLUSIONS
  Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints. Key points   Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients. • Agreements on diagnoses were generally better than the agreement on individual tests. • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion. • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.
authors.affiliation: a Department of Health and Care Sciences , UiT the Arctic University of Norway , Tromsø , Norway ;
authors.forename: Benny
authors.initials: B
authors.lastname: Storheil
authors.affiliation: b Department of Community Medicine , UiT the Arctic University of Norway , Tromsø , Norway.
authors.forename: Elise
authors.initials: E
authors.lastname: Klouman
authors.affiliation: b Department of Community Medicine , UiT the Arctic University of Norway , Tromsø , Norway.
authors.forename: Stian
authors.initials: S
authors.lastname: Holmvik
authors.affiliation: a Department of Health and Care Sciences , UiT the Arctic University of Norway , Tromsø , Norway ;
authors.forename: Nina
authors.initials: N
authors.lastname: Emaus
authors.affiliation: b Department of Community Medicine , UiT the Arctic University of Norway , Tromsø , Norway.
authors.forename: Nils
authors.initials: N
authors.lastname: Fleten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002062:Bursitis / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011320:Primary Health Care; D015203:Reproducibility of Results; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000175:diagnosis*; D052256:Tendinopathy / Q000175:diagnosis; D055815:Young Adult
keywords: Cyriax; Norway; Sweden; general practice; orthopaedic medicine; selective tissue tension techniques; shoulder complaints; shoulder diagnosis; shoulder pain