Crank Test: Difference between revisions
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'''Original Editor '''- [[User:Stacy S Stone|Stacy S Stone]]  
'''Original Editor '''- [[User:Stacy S Stone|Stacy S Stone]]  


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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. <ref name="Munro et al" />
== 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>
 
Liu SH, Henry MH,&nbsp;Nuccion S, Shapiro MS,&nbsp;Dorey F. Diagnosis of glenoid labral tears:&nbsp;a comparison between magnetic resonance imaging and clinical examinations.&nbsp;''Am J Sports Med''. 1996;24(2):149–154.


<br>We studied 54 patients with shoulder pain secondary to anterior instability or glenoid labral tears refractory to 6 months of conservative management with no evidence of rotator cuff lesions. All patients had sufficient preoperative clinical data, magnetic resonance imaging, and shoulder arthroscopy results for analysis. The ability to predict the presence of a glenoid labral tear by physical examination was compared with that of magnetic resonance imaging (conventional and arthrogram) and confirmed with arthroscopy. There were 37 men and 17 women (average age, 34 years) in the study group. Of this group, 64% were throwing athletes and 61% recalled specific traumatic events. Clinical assessment included history with specific attention to pain with overhead activities, clicking, and instances of shoulder instability. Physical examination included the apprehension, relocation, load and shift, inferior sulcus sign, and crank tests. Shoulder arthroscopy confirmed labral tears in 41 patients (76%). Magnetic resonance imaging produced a sensitivity of 59% and a specificity of 85%. Physical examination yielded a sensitivity of 90% and a specificity of 85%. Physical examination is more accurate in predicting glenoid labral tears than magnetic resonance imaging. In this era of cost containment, completing the diagnostic workup in the clinic without expensive ancillary studies allows the patient's care to proceed in the most timely and economic fashion. Glenoid labral tears have been associated with overhead throwing activities, trauma, and shoulder instability. Assessment of an athlete with shoulder pain should take into account a careful history of clicking sounds or catching, symptoms with overhead activities, reports of instability, or previous trauma. On physical examination, patients with labral tears often demonstrate objective instability with or without clicking or catching during glenohumeral rotation. Plain radiographs have not been helpful, and radiologists have relied on techniques from arthrogram to arthrotomogram, CT arthrogram, magnetic resonance imaging (MRI), and MR arthrogram to assist in the diagnosis. Various sensitivities and specificities have been reported for these tests. However, a large degree of intra- and interobserver variability has been demonstrated, and the degree to which these studies are helpful in preoperative planning has been questioned. No previous study to our knowledge has involved MRI in a direct comparison of other diagnostic modalities. Therefore, the purpose of this study is to investigate the accuracy of MRI and physical examination in the diagnosis of glenoid labral tears.
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References  ==
== References  ==


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[[Category:Articles]] [[Category:Assessment]] [[Category:EIM_Student_Project]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Shoulder]] [[Category:Special_Tests]]
[[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, Kehinde Fatola, Rachael Lowe, 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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