February 19, 2014
“Which physical examination tests provide clinicians with the most value when examining the shoulder?”
Update of a systematic review with metanalysis of individual tests.
An extremely thorough analysis of the all of the medical literature on medical tests for shoulder problems was published in the British Journal of Sports Medicine, Volume 46, 2012, page 964-978, by Dr. Eric Hegedus. This extremely thorough, critical analysis of the literature, in my opinion, points out the futility of trying to draw conclusions on internal shoulder pathology with clinical physical exam tests. There was very little to support the use of any clinical tests because of the poor design of the studies that have been published and the low sensitivities and low specificities of the tests. No test had both a high sensitivity and a high specificity. At best, the tests would have high sensitivity and low specificity or the opposite.
Based upon this, I am inclined to think we need to base our decisions to what operative equipment to have available based on the duration of a person’s symptoms, general physical exam findings, plain x-ray and MRI, and not waste our time with the many seemingly bogus tests that many authors have tried to put together to support elusive diagnoses such as a “SLAP” tear, which is quite rare, and be absolutely certain of biceps tendinopathy, etc.