Internal Rotation Lag Sign: Difference between revisions
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'''Original Editor '''- [[User:Ron Bucholtz|Ron Bucholtz]] | |||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | |||
</div> | |||
= | == Purpose == | ||
To test for [[Rotator Cuff Tears|rotator cuff tears]] of the Subscapularis tendon. | |||
== Technique == | |||
# Patient is seated with examiner standing behind the patient. | |||
# The affected arm is brought into maximal internal rotation behind the back (dorsum of patients hand against the lumbar region). | |||
# Examiner controls patient's arm at the elbow and wrist/hand which is passively brought into 20 degrees of extension, taking the forearm and hand away from the back. | |||
# The patient is instructed to actively maintain this position, as the examiner releases the wrist but maintains support at the elbow. | |||
= Evidence = | A lag is indicative of a subscapularis tendon tear. <ref name="Hertel">Hertel R, Balmer FT, Lombert SM, Gerber C. [http://www.ncbi.nlm.nih.gov/pubmed/8872929 Lag signs in the diagnosis of rotator cuff rupture.] Journal of Shoulder and Elbow Surgery. 1996 Jul-Aug:5(4):307-313.</ref><ref name="Miller">Miller CA, Forrester GA, Lewis JS. [http://www.ncbi.nlm.nih.gov/pubmed/18503815 The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation.] Archives of Physical and Medical Rehabilitation. 2008 Jun:89(6):1162-1168.</ref><ref name="Magosch">Magosch SM, Pritsch M, Lichtenberg S, Habemeyer P. [http://www.ncbi.nlm.nih.gov/pubmed/16226652 The belly-off sign: a new clinical diagnostic sign for subscapularis lesions.] Arthroscopy: 2005 Oct:21(10):1229-1235.</ref><ref name="Cleland">Cleland J. Orthopaedic Clincial Examination: An Evidence Based Approach for Physical Therapists: Philadelphia: Saunders - Elsevier. 2007</ref><ref name="Magee">Magee, DJ.&nbsp; Orthopedic Physical Assessment:& St. Louis:& Saunders - Elsevier:& (4th Ed.)</ref> | ||
Hertel, et. al. | Hertel, et. al. describe the magnitude of the lag in 5 degree increments with an obvious drop indicating a large or massive tear, and a smaller lag revealing a partial tear. <ref name="Hertel" /> | ||
Please note that the Internal Rotation Lag Sign (IRLS) is also described by Magee as the "'''subscaplaris '''or '''medial rotation''' '<nowiki/>'''spring back' '''or '<nowiki/>'''lag test'''' in addition to the "'''modified lift-off test'''". <ref name="Magee" /> | |||
{{#ev:youtube|3pzE4Uptx6o|300}}<ref>CRTechnologies. Internal Rotation Lag Sign - Shoulder Test. Available from: http://www.youtube.com/watch?v=3pzE4Uptx6o, last accessed 8 December 2009</ref> | |||
== Evidence == | |||
= | Hertel, et. al.<ref name="Hertel" /> (also cited in Cleland) <ref name="Cleland" /> report Sensitivity (Sn) .97, Specificity (Sp) .96, positive Likelihood ratio (LR+) 24.3, and negative Likelihood Ratio (LR-) of .03 for the IRLS. | ||
A more recent study by Miller, et. al. report Sn 1.0, Sp .84, LR+ 6.2, LR- 0.0 with Positive Predictive Value (PPV) 28% and Negative Predictive Value (NPV) of 100 for the IRLS. These values are compared to diagnostic ultrasound which has been found to be comparable with arthroscopy for diagnosing RTC tears. However, they summarize that clinical diagnosis of ''full-thickness tears of the rotator cuff cannot be conclusively reached using one or more of the lag signs''. The other lag signs investigated in this study are the drop sign and external rotation lag sign (ERLS). <ref name="Miller" /><br> | |||
== References == | |||
<references /> | |||
[[Category:Assessment]] | |||
[[Category:Shoulder]] | |||
[[Category:Special_Tests]] | |||
[[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 00:04, 24 May 2024
Original Editor - Ron Bucholtz
Top Contributors - Ron Bucholtz, Admin, Scott Buxton, Kim Jackson, Naomi O'Reilly, Kai A. Sigel, WikiSysop, Wanda van Niekerk, Kapil Narale, 127.0.0.1, Tony Lowe and Evan Thomas
Purpose[edit | edit source]
To test for rotator cuff tears of the Subscapularis tendon.
Technique[edit | edit source]
- Patient is seated with examiner standing behind the patient.
- The affected arm is brought into maximal internal rotation behind the back (dorsum of patients hand against the lumbar region).
- Examiner controls patient's arm at the elbow and wrist/hand which is passively brought into 20 degrees of extension, taking the forearm and hand away from the back.
- The patient is instructed to actively maintain this position, as the examiner releases the wrist but maintains support at the elbow.
A lag is indicative of a subscapularis tendon tear. [1][2][3][4][5]
Hertel, et. al. describe the magnitude of the lag in 5 degree increments with an obvious drop indicating a large or massive tear, and a smaller lag revealing a partial tear. [1]
Please note that the Internal Rotation Lag Sign (IRLS) is also described by Magee as the "subscaplaris or medial rotation 'spring back' or 'lag test' in addition to the "modified lift-off test". [5]
Evidence[edit | edit source]
Hertel, et. al.[1] (also cited in Cleland) [4] report Sensitivity (Sn) .97, Specificity (Sp) .96, positive Likelihood ratio (LR+) 24.3, and negative Likelihood Ratio (LR-) of .03 for the IRLS.
A more recent study by Miller, et. al. report Sn 1.0, Sp .84, LR+ 6.2, LR- 0.0 with Positive Predictive Value (PPV) 28% and Negative Predictive Value (NPV) of 100 for the IRLS. These values are compared to diagnostic ultrasound which has been found to be comparable with arthroscopy for diagnosing RTC tears. However, they summarize that clinical diagnosis of full-thickness tears of the rotator cuff cannot be conclusively reached using one or more of the lag signs. The other lag signs investigated in this study are the drop sign and external rotation lag sign (ERLS). [2]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Hertel R, Balmer FT, Lombert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. Journal of Shoulder and Elbow Surgery. 1996 Jul-Aug:5(4):307-313.
- ↑ 2.0 2.1 Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Archives of Physical and Medical Rehabilitation. 2008 Jun:89(6):1162-1168.
- ↑ Magosch SM, Pritsch M, Lichtenberg S, Habemeyer P. The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy: 2005 Oct:21(10):1229-1235.
- ↑ 4.0 4.1 Cleland J. Orthopaedic Clincial Examination: An Evidence Based Approach for Physical Therapists: Philadelphia: Saunders - Elsevier. 2007
- ↑ 5.0 5.1 Magee, DJ. Orthopedic Physical Assessment:& St. Louis:& Saunders - Elsevier:& (4th Ed.)
- ↑ CRTechnologies. Internal Rotation Lag Sign - Shoulder Test. Available from: http://www.youtube.com/watch?v=3pzE4Uptx6o, last accessed 8 December 2009