Subacromial Impingement Cluster: Difference between revisions
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== Purpose == | == Purpose == | ||
To test for the presence of subacromial impingement | To test for the presence of subacromial impingement | ||
==Tests for Subacromial Impingement<sup>1,2</sup>== | == Tests for Subacromial Impingement<sup>1,2</sup> == | ||
'''Hawkins-Kennedy''': SN: .63 (.39–.86) SP: .62 (.46–.77) +LR: 1.63 (.94–2.81) | '''Hawkins-Kennedy''': SN: .63 (.39–.86) SP: .62 (.46–.77) +LR: 1.63 (.94–2.81) | ||
*Testing: Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees. | *Testing: Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees. | ||
*Positive Test: Pain with IR. | |||
'''Neer''': SN: .81 (.62–1.0) SP: .54 (.38–.69) +LR: 1.76 (1.17–2.66) | |||
*Testing: Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM. | *Testing: Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM. | ||
*Positive Test: Pain with flexion | |||
'''Painful arc''': SN: .75 (.54–.96) SP: .67 (.52–.81) +LR: 2.25 (1.33–3.81) | |||
*Testing: Shoulder is elevated in scaption and then | *Testing: Shoulder is elevated in scaption to full elevation and then lowered in same motion. | ||
*Positive Test: Pain or pain from 60 to 120 degrees scaption | |||
'''Empty can (Jobe): '''SN: .50 (.26–.75) SP: .87 (.77–.98) +LR: 3.90 (1.50–10.12) | |||
*Testing: Shoulder abducted to 90 degrees and slightly adducted. Shoulder internally rotated and downward force applied. | *Testing: Shoulder abducted to 90 degrees and slightly adducted. Shoulder internally rotated and downward force applied. | ||
*Positive Test: Pain or inability to maintain abduction. | |||
'''External rotation resistance: '''SN: .56 (.32–.81) SP: .87 (.77–.98) +LR: 4.39 (1.74–11.07) .50 | |||
Testing: Elbow flexed to 90 degrees and adducted to trunk with neutral rotation. Medially directed force applied. | *Testing: Elbow flexed to 90 degrees and adducted to trunk with neutral rotation. Medially directed force applied. | ||
*Positive Test: Pain or weakness | |||
Positive Test: Pain or | '''Cross-body adduction test''': SN: .23 SP: .82 | ||
*Testing: Shoulder is elevated to 90 degrees and adducted across body. | |||
*Positive Test: Pain with adduction | |||
'''Drop arm sign''': SN: .27 SP: .88 | |||
*Testing: Shoulder is elevated to full flexion and asked to slowly lower. | |||
*Positive Test: Severe pain or inability to slowly lower. | |||
==Clusters== | |||
If three of the following test are positive: Hawkins-Kennedy, neer, painful arc, empty can, and external rotation resistance then SN: .75 (.54–.96) SP: .74 (.61–.88) +LR: 2.93 (1.60–5.36) -LR: .34 (.14–.80).<sup>1</sup> | |||
If Painfui arc sign, Drop-arm sign, Infraspinatus muscle test positive the +LR: 15.57 of full thickness rotator cuff tear.<sup>2</sup> | |||
If Hawkins-Kennedy impingement sign, Painfui arc sign, Infraspinatus muscle test positive then +LR: 10.56 of some type of impingement present.<sup>2</sup> | |||
==References== | |||
(1) Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009 Nov;90(11):1898-903.<br> | |||
(2) Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005 Jul;87(7):1446-55. |
Revision as of 06:04, 12 December 2009
Purpose[edit | edit source]
To test for the presence of subacromial impingement
Tests for Subacromial Impingement1,2[edit | edit source]
Hawkins-Kennedy: SN: .63 (.39–.86) SP: .62 (.46–.77) +LR: 1.63 (.94–2.81)
- Testing: Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees.
- Positive Test: Pain with IR.
Neer: SN: .81 (.62–1.0) SP: .54 (.38–.69) +LR: 1.76 (1.17–2.66)
- Testing: Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM.
- Positive Test: Pain with flexion
Painful arc: SN: .75 (.54–.96) SP: .67 (.52–.81) +LR: 2.25 (1.33–3.81)
- Testing: Shoulder is elevated in scaption to full elevation and then lowered in same motion.
- Positive Test: Pain or pain from 60 to 120 degrees scaption
Empty can (Jobe): SN: .50 (.26–.75) SP: .87 (.77–.98) +LR: 3.90 (1.50–10.12)
- Testing: Shoulder abducted to 90 degrees and slightly adducted. Shoulder internally rotated and downward force applied.
- Positive Test: Pain or inability to maintain abduction.
External rotation resistance: SN: .56 (.32–.81) SP: .87 (.77–.98) +LR: 4.39 (1.74–11.07) .50
- Testing: Elbow flexed to 90 degrees and adducted to trunk with neutral rotation. Medially directed force applied.
- Positive Test: Pain or weakness
Cross-body adduction test: SN: .23 SP: .82
- Testing: Shoulder is elevated to 90 degrees and adducted across body.
- Positive Test: Pain with adduction
Drop arm sign: SN: .27 SP: .88
- Testing: Shoulder is elevated to full flexion and asked to slowly lower.
- Positive Test: Severe pain or inability to slowly lower.
Clusters[edit | edit source]
If three of the following test are positive: Hawkins-Kennedy, neer, painful arc, empty can, and external rotation resistance then SN: .75 (.54–.96) SP: .74 (.61–.88) +LR: 2.93 (1.60–5.36) -LR: .34 (.14–.80).1
If Painfui arc sign, Drop-arm sign, Infraspinatus muscle test positive the +LR: 15.57 of full thickness rotator cuff tear.2
If Hawkins-Kennedy impingement sign, Painfui arc sign, Infraspinatus muscle test positive then +LR: 10.56 of some type of impingement present.2
References[edit | edit source]
(1) Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009 Nov;90(11):1898-903.
(2) Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005 Jul;87(7):1446-55.