Examination of the shoulder: the past, the present, and the future.

Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 3.23). 11/2009; 91 Suppl 6:10-8. DOI: 10.2106/JBJS.I.00534
Source: PubMed
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    ABSTRACT: It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determine the diagnostic value of individual clinical tests and to develop a prediction model that combined patient characteristics, history, and clinical tests for diagnosis of traumatic anterior shoulder instability. This prospective cohort study included 169 consecutive patients with shoulder complaints who were examined at an orthopaedic outpatient clinic. One experienced clinician conducted 25 clinical tests; of these, 6 were considered to be specific for testing of traumatic anterior shoulder instability (apprehension, relocation, release, anterior drawer, load and shift, and hyperabduction tests). Magnetic resonance arthrography was used to determine the final diagnosis. A prediction model was developed by logistic regression analysis. In this cohort, 60 patients (36%) were diagnosed with anterior shoulder instability on the basis of magnetic resonance arthrography. The overall accuracy of individual clinical tests was 80.5% to 86.4%. Age, previous shoulder dislocation, sudden onset of complaints, and the release test were important predictors for the diagnosis of traumatic anterior shoulder instability. The prediction model demonstrated high discriminative ability (AUC 0.95). Individual clinical shoulder tests provide good diagnostic accuracy. Young age, history of shoulder dislocation, sudden onset of complaints, and positive result of the release test were the most important predictors for traumatic anterior shoulder instability.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2013; · 1.93 Impact Factor
  • PM&R 05/2013; 5(5):445-446. · 1.37 Impact Factor
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    ABSTRACT: Comparative effectiveness research evaluates treatments as actually delivered in routine clinical practice, shifting research focus from efficacy and internal validity to effectiveness and external validity ("generalizability"). Such research requires accurate assessments of the numbers of patients treated and the completeness of their followup, their clinical outcomes, and the setting in which their care was delivered. Choosing measures and methods for clinical outcome research to produce meaningful information that may be used to improve patient care presents a number of challenges. WHERE ARE WE NOW?: Orthopaedic surgery research has many stakeholders, including patients, providers, payers, and policy makers. A major challenge in orthopaedic surgery outcome measurement and clinical research is providing all of these users with valid information for their respective decision making. At present, no plan exists for capturing data on such a broad scale and scope. WHERE DO WE NEED TO GO?: Practical challenges include identifying and obtaining resources for widespread data collection and merging multiple data sources. Challenges of study design include sampling to obtain representative data, timing of data collection in the episode of care, and minimizing missing data and study dropout. HOW DO WE GET THERE?: Resource limitations may be addressed by repurposing existing clinical resources and capitalizing on technologic advances to increase efficiencies. Increasing use of rigorous, well-designed observational research designs can provide information that may be unattainable in clinical trials. Such study designs should incorporate methods to minimize missing data, to sample multiple providers, facilities, and patients, and to include evaluation of potential confounding variables to minimize bias and allow generalization to broad populations.
    Clinical Orthopaedics and Related Research 07/2013; · 2.79 Impact Factor

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