Crank Test: Difference between revisions

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== Purpose<br> ==


To identify glenoid labral tears.<br>
== Purpose  ==


== Technique<br> ==
This test also called labral crank test or compression rotation test is used to identify glenoid labral tears and assess an unstable superior labral anterior posterior (SLAP) lesions. <ref name=":0">Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010.</ref><br>


Patient is upright with the arm elevated to 160° in the scapular plane. Joint load is applied along the axis of the humerus with one hand while the other hand performs humeral rotation. The test can be repeated in supine. A positive test is indicated during the manuver (usually during external rotation)&nbsp;if there is reproduction of symptoms&nbsp;with or without a click.
== Technique  ==


== Evidence  ==
{{#ev:youtube|3CLvoC21hTo|250}} <ref>Clinically Relevant Technologies, http://www.youtube.com/watch?v=3CLvoC21hTo[last accessed 22/03/13]</ref>


Patient is sitting upright with the arm flexed to 90°, the examiner stands adjacent to the affected shoulde forearmr holding the flexed elbow or forearm. <ref name=":0" /> Joint load is applied along the axis of the humerus with one hand while the other hand performs humeral rotation while the shoulder is being elevated in the scapular plane. The test can be repeated in supine. A positive test is indicated during the maneuver (usually during external rotation) if there is reproduction of symptoms (usually pain) with or without a click. <ref name="Munro et al" />
<br>
<br>


{| cellspacing="1" cellpadding="1" width="200" border="1"
== Evidence  ==
 
{| width="100%" cellspacing="1" cellpadding="1" border="1"
|-
|-
| <u>'''First author<br>'''</u>
| <u>'''First author<br>'''</u>  
| <u>'''Sensitivity (95% CI)<br>'''</u>
| <u>'''Sensitivity (95% CI)<br>'''</u>  
| <u>'''Specificity (95% CI)<br>'''</u>
| <u>'''Specificity (95% CI)<br>'''</u>  
| <u>'''+LR (95% CI)<br>'''</u>
| <u>'''+LR (95% CI)<br>'''</u>  
| <u>'''-LR (95% CI)<br>'''</u>
| <u>'''-LR (95% CI)<br>'''</u>  
| <u>'''Accuracy (%)<br>'''</u>
| <u>'''Accuracy (%)<br>'''</u>
|-
|-
| Guanche 2003<br>
| Guanche 2003  
| 0.4<br>
| 0.4  
| 0.73<br>
| 0.73  
| 1.481<br>
| 1.481  
| 0.821<br>
| 0.821  
|  
|  
|-
|-
| Liu 1996<br>
| Liu 1996  
| 0.906 (0.750–0.980)<br>
| 0.906 (0.750–0.980)  
| 0.933 (0.779–0.992)<br>
| 0.933 (0.779–0.992)  
| 13.594 (3.547–52.099)<br>
| 13.594 (3.547–52.099)  
| 0.100 (0.034–0.296)<br>
| 0.100 (0.034–0.296)  
| 91.9<br>
| 91.9
|-
|-
| Mimori 1999<br>
| Mimori 1999
| 0.833 (0.516–0.979)<br>
| 0.833 (0.516–0.979)
| 1.000 (0.292–1.000)<br>
| 1.000 (0.292–1.000)
| 6.462 (0.477–87.549)<br>
| 6.462 (0.477–87.549)
| 0.220 (0.068–0.711)<br>
| 0.220 (0.068–0.711)
| 86.6<br>
| 86.6
|-
|-
| Myers 2005<br>
| Myers 2005
| 0.346<br>
| 0.346
| 0.7<br>
| 0.7
| Not calculated
| Not calculated  
| Not calculated
| Not calculated  
| 44.4<br>
| 44.4
|-
|-
| Nakagawa 2005<br>
| Nakagawa 2005
| 0.58<br>
| 0.58
| 0.72<br>
| 0.72
| Not calculated
| Not calculated  
| Not calculated
| Not calculated  
| 66<br>
| 66
|-
|-
| Parentis 2006<br>
| Parentis 2006
| 0.087<br>
| 0.087
| 0.826<br>
| 0.826  
| Not calculated
| Not calculated  
| Not calculated
| Not calculated  
|  
|  
|-
|-
| Stetson and Templin 2002<br>
| Stetson and Templin 2002
| 0.462 (0.266–0.666)<br>
| 0.462 (0.266–0.666)
| 0.564 (0.396–0.722)<br>
| 0.564 (0.396–0.722)
| 1.059 (0.612–1.831)<br>
| 1.059 (0.612–1.831)
| 0.955 (0.608–1.497)<br>
| 0.955 (0.608–1.497)
| 33.8<br>
| 33.8
|}
|}


<ref name="Munro et al">Munro W, Healy R. The validity and accuracy of clinical tests used to detect labral pathology of the shoulder-a systematic review. Manual Therapy 2009; 14(2):119-30.</ref> <br>
<ref name="Munro et al">Munro W, Healy R. The validity and accuracy of clinical tests used to detect labral pathology of the shoulder-a systematic review. Manual Therapy 2009; 14(2):119-30.</ref> <br>  


== Resources  ==
== Resources  ==


Guanche CA, Jones DC.&nbsp; Clinical testing for tears of the glenoid labrum. ''Arthroscopy.''&nbsp; 2003;19:517-523.  
*Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. ''Arthroscopy.'' 2003;19:517-523.<br>
 
*Liu SH, Henry MH, Nuccion S, Shapiro MS, Dorey F. Diagnosis of glenoid labral tears: a comparison between magnetic resonance imaging and clinical examinations. ''Am J Sports Med''. 1996;24(2):149–154.<br>
<br>PURPOSE: With the increasing use of shoulder arthroscopy, diagnosis of glenoid labral lesions has become increasingly common. However, a physical examination maneuver that would allow a definitive clinical diagnosis of a glenoid labral tear, and more specifically a SLAP lesion, has been elusive. This study correlated the results of commonly used examination maneuvers with findings at shoulder arthroscopy. The working hypothesis was that 7 commonly used clinical tests, alone or in logical combinations, would provide diagnoses with reliability greater than the accepted standards for magnetic resonance imaging arthrography; i.e., greater than 95% sensitivity and specificity. TYPE OF STUDY: Consecutive sample, sensitivity-specificity study. METHODS: Sixty shoulders undergoing arthroscopy for a variety of pathologies were examined before surgery. All subjects submitted to the Speed test, an anterior apprehension maneuver, Yergason test, O'Brien test, Jobe relocation test, the crank test, and a test for tenderness of the bicipital groove. The examination results were compared with surgical findings and analyzed for sensitivity and specificity in the diagnosis of SLAP lesions and other glenoid labral tears. RESULTS: The results of the O'Brien test (63% sensitive, 73% specific) and Jobe relocation test (44% sensitive, 87% specific) were statistically correlated with presence of a tear in the labrum and the apprehension test approached statistical significance. Performing all 3 tests and accepting a positive result for any of them increased the statistical value, although the sensitivity and specificity were still disappointingly low (72% and 73%, respectively). The other 4 tests were not found to be useful for labral tears, and none of the tests or combinations were statistically valid for specific detection of a SLAP lesion. CONCLUSIONS: Clinical testing is useful in strengthening a diagnosis of a glenoid labral lesion, but the sensitivity and specificity are relatively low. Thus a decision to proceed with surgery should not be based on clinical examination alone.<br><br>


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
<references />  
 
<references />


[[Category:Articles]] [[Category:Assessment]] [[Category:EIM_Student_Project]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Shoulder]] [[Category:Special_Test]]
[[Category:Assessment]]
[[Category:Special_Tests]]
[[Category:Shoulder]]  
[[Category:Shoulder - Special Tests]]  
[[Category:Shoulder - Assessment and Examination]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category:EIM_Residency_Project]]
[[Category:Sports Medicine]]
[[Category:Sports Injuries]]
[[Category:Athlete Assessment]]

Latest revision as of 17:26, 21 November 2020

Original Editor - Stacy S Stone

Top Contributors - Admin, Stacy S Stone, Rachael Lowe, Kehinde Fatola, Scott Buxton, WikiSysop, Kim Jackson, Tony Lowe, Dan Rhon, Laura Ritchie, Evan Thomas, Naomi O'Reilly, Kai A. Sigel and Wanda van Niekerk

Purpose[edit | edit source]

This test also called labral crank test or compression rotation test is used to identify glenoid labral tears and assess an unstable superior labral anterior posterior (SLAP) lesions. [1]

Technique[edit | edit source]

[2]

Patient is sitting upright with the arm flexed to 90°, the examiner stands adjacent to the affected shoulde forearmr holding the flexed elbow or forearm. [1] Joint load is applied along the axis of the humerus with one hand while the other hand performs humeral rotation while the shoulder is being elevated in the scapular plane. The test can be repeated in supine. A positive test is indicated during the maneuver (usually during external rotation) if there is reproduction of symptoms (usually pain) with or without a click. [3]

Evidence[edit | edit source]

First author
 		Sensitivity (95% CI)
 		Specificity (95% CI)
 		+LR (95% CI)
 		-LR (95% CI)
 		Accuracy (%)
Guanche 2003 0.4 0.73 1.481 0.821
Liu 1996 0.906 (0.750–0.980) 0.933 (0.779–0.992) 13.594 (3.547–52.099) 0.100 (0.034–0.296) 91.9
Mimori 1999 0.833 (0.516–0.979) 1.000 (0.292–1.000) 6.462 (0.477–87.549) 0.220 (0.068–0.711) 86.6
Myers 2005 0.346 0.7 Not calculated Not calculated 44.4
Nakagawa 2005 0.58 0.72 Not calculated Not calculated 66
Parentis 2006 0.087 0.826 Not calculated Not calculated
Stetson and Templin 2002 0.462 (0.266–0.666) 0.564 (0.396–0.722) 1.059 (0.612–1.831) 0.955 (0.608–1.497) 33.8

[3]

Resources[edit | edit source]

  • Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19:517-523.
  • Liu SH, Henry MH, Nuccion S, Shapiro MS, Dorey F. Diagnosis of glenoid labral tears: a comparison between magnetic resonance imaging and clinical examinations. Am J Sports Med. 1996;24(2):149–154.

References[edit | edit source]

  1. ↑ 1.0 1.1 Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010.
  2. ↑ Clinically Relevant Technologies, http://www.youtube.com/watch?v=3CLvoC21hTo[last accessed 22/03/13]
  3. ↑ 3.0 3.1 Munro W, Healy R. The validity and accuracy of clinical tests used to detect labral pathology of the shoulder-a systematic review. Manual Therapy 2009; 14(2):119-30.
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