Crank Test: Difference between revisions
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Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. ''Arthroscopy.'' 2003;19:517-523. | Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. ''Arthroscopy.'' 2003;19:517-523. | ||
<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> | <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. | ||
Liu et al., 1996a S.H. Liu, M.H. Henry, S. Nuccion, M.S. Shapiro and F. Dorey, Diagnosis of glenoid labral tears. A comparison between magnetic resonance imaging and clinical examinations, The American Journal of Sports Medicine 24 (2) (1996), pp. 149–154<br><br> | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 20:01, 2 July 2009
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Original Editor - Stacy S Stone
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Purpose
[edit | edit source]
To identify glenoid labral tears.
Technique
[edit | edit source]
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) if there is reproduction of symptoms with or without a click.
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 |
Resources[edit | edit source]
Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19:517-523.
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.
Liu et al., 1996a S.H. Liu, M.H. Henry, S. Nuccion, M.S. Shapiro and F. Dorey, Diagnosis of glenoid labral tears. A comparison between magnetic resonance imaging and clinical examinations, The American Journal of Sports Medicine 24 (2) (1996), pp. 149–154
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 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.
