Reliability and diagnostic accuracy of history and physical examination for diagnosing glenoid labral tears

Department of Physical Therapy, Virginia Commonwealth University-Medical College of Virginia, Richmond, VA 23298, USA.
The American Journal of Sports Medicine (Impact Factor: 4.7). 02/2008; 36(1):162-8. DOI: 10.1177/0363546507307508
Source: PubMed

ABSTRACT Glenoid labral tears provide a diagnostic challenge.
Combinations of items in the patient history and physical examination will provide stronger diagnostic accuracy to suggest the presence or absence of glenoid labral tear than will individual items.
Cohort study (diagnosis); Level of evidence, 1.
History and examination findings in patients with shoulder pain (N = 55) were compared with arthroscopic findings to determine diagnostic accuracy and intertester reliability.
The intertester reliability of the crank, anterior slide, and active compression tests was 0.20 to 0.24. A combined history of popping or catching and positive crank or anterior slide results yielded specificities of 0.91 and 1.00 and positive likelihood ratios of 3.0 and infinity, respectively. A positive anterior slide result combined with either a positive active compression or crank result yielded specificities of 0.91 and positive likelihood ratio of 2.75 and 3.75, respectively. Requiring only a single positive finding in the combination of popping or catching and the anterior slide or crank yielded sensitivities of 0.82 and 0.89 and negative likelihood ratios of 0.31 and 0.33, respectively.
The diagnostic accuracy of individual tests in previous studies is quite variable, which may be explained in part by the modest reliability of these tests. The combination of popping or catching with a positive crank or anterior slide result or a positive anterior slide result with a positive active compression or crank test result suggests the presence of a labral tear. The combined absence of popping or catching and a negative anterior slide or crank result suggests the absence of a labral tear.

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    • "The active compression test is reported to differentiate between acromioclavicular joint and glenoid labrum pathology (O'Brien et al., 1998). Previous studies indicate 'fair' reliability (kappa 0.24; 95% CI À0.02, 50) for the combined result of the active compression test for both pathologies (Walsworth et al., 2008). No studies were identified that tested the interexaminer reliability of differentiated test results of the active compression test for the two separate pathologies. "
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    ABSTRACT: Orthopaedic special tests (OST) are commonly used in the assessment of the painful shoulder to assist to rule-in or rule-out specific pathology. A small number of tests with high levels of diagnostic accuracy have been identified but interexaminer reliability data is variable or lacking. The aim of this study was to determine the interexaminer reliability of a group of OST with demonstrated diagnostic accuracy at primary care level. Forty consecutive subjects with shoulder pain were recruited. Six tests were performed by two examiners (physiotherapists) on the same day. Tests included the active compression test, Hawkins-Kennedy test, drop-arm test, crank test, Kim test and belly-press test. 'Fair' reliability (kappa 0.36-0.38) was observed for the active compression test (labral pathology), Hawkins-Kennedy test and crank test. Prevalence of positive agreements was low for the active compression test (acromioclavicular joint), drop-arm test, Kim test and belly-press test. Prevalence and bias adjusted kappa (PABAK) values indicated 'substantial' reliability (0.65-0.78) for these tests. The active compression test (acromioclavicular joint), belly-press tests (observation and weakness), Kim test and drop-arm test demonstrate acceptable levels of interexaminer reliability in a group of patients with sub-acute and chronic shoulder conditions.
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    • "0.24 −0.02 to 0.50 Anterior slide test Walsworth 2008 [70] 0.21 −0.05 to 0.46 Crank test Walsworth 2008 [70] 0.20 −0.05 to 0.46 Biceps load test Kim 1999 [50] "
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