Rent Test
Original Editor - Ron Bucholtz
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Introduction
The Rent test, first described by Codman in 1934, is a clinical assessment that involves palpating the anterior insertion point of the greater tuberosity to identify any crepitus, which can indicate supraspinatus tendon deficiencies.[1]
Rotator cuff tears include a variety of tear sizes and locations, with patients presenting with a spectrum of findings from no pain to severe shoulder pain and normal function to severe dysfunction.[1] The rent test also known as the trans-deltoid palpation is a clinical examination used to diagnose the full thickness of the rotator cuff tear,[2]and may be the best physical examination for detecting rotator cuff tears.[3]
Purpose
To test for the presence of rotator cuff tears.
The rent test is used in addition to other rotator cuff tear tests (Jobe test, Drop arm sign, Belly-press test, List-off test, Bear-hug test) to determine the location of the tear.[1]
Technique
The patient is seated, with the examiner standing behind the patient. Have the patient relax - palpate the anterior margin of the acromion through the deltoid - while doing this grasp the patient's arm with the other hand at the elbow/forearm (patient's elbow should be flexed to ~ 90 degrees) and bring into extension. Passively internally and externally rotate the patient's arm to palpate rotator cuff tendons. The presence of palpable or prominent eminence (Greater tuberosity) and/or rent (defect or 'sulcus')[2] is indicative of a full-thickness tear. [2][4]
Evidence
Wolf and Agrawal[2] report Sensitivity and Specificity of 95.7% (.96[4]) and 96.8% (.97[4]) respectively with a positive predictive value of 95.7%, negative predictive value of 96.8% and a diagnostic accuracy of 96.3%. Cleland[4] calculates a +LR of 32.0 and -LR of .04. Lyons and Tomlinson[5] reported Sn of 91% (.91) and Sp of 75% (.75).
References
- ↑ 1.0 1.1 1.2 Moulton SG, Greenspoon JA, Millett PJ, Petri M. Suppl 1: M3: risk factors, pathobiomechanics and physical examination of rotator cuff tears. The open orthopaedics journal. 2016;10:277.
- ↑ 2.0 2.1 2.2 2.3 Dutton M. Orthopaedic Examination, Evaluation, and Intervention. New York: The McGraw-Hill Companies (2nd Ed.) 2008
- ↑ 3.0 3.1 Clinically Relevant Technologies, http://www.youtube.com/watch?v=YA6oasQWGFA, Accessed May 2011
- ↑ 4.0 4.1 4.2 4.3 Cleland J. Orthopaedic Clinical Examination: An Evidence-Based Approach for Physical Therapists. Philadelphia; Saunders, Elsevier: 2007
- ↑ Lyons AR & Tomlinson JE. Clinical Diagnosis of Tears of the Rotator Cuff. J Bone Joint Surg. May 1991;(74):404-405