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Rheumatology Advance Access published online on March 27, 2008
Rheumatology, doi:10.1093/rheumatology/ken101
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Accuracy of physical examination in subacromial impingement syndrome

L. Silva1, J. L. Andréu1, P. Muñoz1, M. Pastrana2, I. Millán3, J. Sanz1, C. Barbadillo1 and M. Fernández-Castro1

1Department of Rheumatology, 2Department of Imaging and 3Department of Biostatistics, Hospital Universitario Puerta de Hierro, Madrid, Spain.

Correspondence to: J. L. Andreu, Servicio de Reumatología, Hospital Universitario Puerta de Hierro, San Martín de Porres 4, Madrid 28035, Spain. E-mail: jlandreu{at}arrakis.es


  Abstract

Objective. Shoulder pain is a common complaint, frequently caused by subacromial impingement syndrome (SIS). There are a number of physical examination (PE) manoeuvres that explore the subacromial space. MRI provides an accurate anatomic image of the subacromial space, being the current gold standard in the diagnosis of SIS. The aim of this study is to evaluate the accuracy of the PE in the diagnosis of SIS and/or subacromial–subdeltoid bursitis (SSB) confirmed by MRI.

Methods. Consecutive outpatients with an episode of shoulder pain were prospectively included in the study. They were examined by a rheumatologist and, within 3 days, an MRI was done. Sensitivity, specificity, positive and negative predictive values, and accuracy of PE manoeuvres were calculated using a 2 x 2 table.

Results. Fourteen males and 16 females were included. All the tests exhibited acceptable sensitivity. As a result Yocum manoeuvre was considered the most sensitive and most accurate for SIS. With regard to SSB, the Gerber test was the most sensitive. The majority of the PE manoeuvres showed low specificity.

Conclusions. Most PE manoeuvres identify reasonably well subacromial impingement of the shoulder, although, in general, they have low specificity. The Yocum test has the best sensitivity and precision. Our data suggest that imaging techniques should be recommended to better define shoulder lesions.

KEY WORDS: Painful shoulder, Subacromial impingement syndrome, Subacromial–subdeltoid bursitis, Clinical evaluation, MRI

Submitted 29 October 2007; revised version accepted 8 February 2008.
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