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. 2013 Apr 30;2013(4):CD007427.
doi: 10.1002/14651858.CD007427.pub2.

Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement

Nigel C A Hanchard  1 , Mário Lenza, Helen H G Handoll, Yemisi Takwoingi
Affiliations

Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement

Nigel C A Hanchard et al. Cochrane Database Syst Rev. .

Abstract

Background: Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting.

Objectives: To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders.

Search methods: We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English.

Selection criteria: We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials.

Data collection and analysis: Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed.

Main results: We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition.

Authors' conclusions: There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.

PubMed Disclaimer

Conflict of interest statement

None known. Nigel Hanchard has recently completed a study on the diagnostic accuracy of physical tests for subacromial and internal shoulder impingement. The ‘reference’ test was ultrasound guided injection of local anaesthetic into the subacromial bursa and shoulder joint.

Figures

1
1
Flow diagram.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study. Coding: + = 'Yes'; ‐ = 'No'; ? = unclear.
3
3
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
4
4
Subacromial and internal impingement
5
5
Rotator cuff tendinopathy or tears ‐ non‐specific disease of the 'rotator cuff'
6
6
Rotator cuff tendinopathy or tears ‐ specific disease of the 'rotator cuff'
7
7
Rotator cuff tendinopathy or tears: non‐specific disease of the 'posterosuperior rotator cuff'
8
8
Rotator cuff tendinopathy or tears: specific disease of the 'posterosuperior rotator cuff'.
9
9
Rotator cuff tendinopathy or tears: non‐specific disease of supraspinatus
10
10
Rotator cuff tendinopathy or tears: specific disease of supraspinatus.
11
11
Rotator cuff tendinopathy or tears: disease of infraspinatus
12
12
Rotator cuff tendinopathy or tears: non‐specific disease of subscapularis
13
13
Rotator cuff tendinopathy or tears: specific disease of subscapularis
14
14
LHB tear or tendinitis
15
15
Glenoid labral lesion: non‐specific labral lesion
16
16
Glenoid labral lesions: non‐specific SLAP lesion
17
17
Glenoid labral lesions: type II‐IV SLAP lesion
18
18
Glenoid labral lesions: type II SLAP lesion
19
19
Non‐specific
1
1. Test
Target condition: SIS. Index test: combination of ALL 7 tests +ve (see table 7)..
2
2. Test
Target condition: SIS. Index test: combination of Hawkins' test AND Neer's sign (modified procedure) +ve..
3
3. Test
Target condition: SIS. Index test: combination of Hawkins' test OR Neer's sign (modified procedure) +ve..
4
4. Test
Target condition: SIS. Index test: drop arm test (modified interpretation)..
5
5. Test
Target condition: SIS. Index test: Gum‐turn test (novel).
6
6. Test
Target condition: SIS. Index test:. Hawkins' test (standard)..
7
7. Test
Target condition: SIS. Index test: Neer's sign (standard)..
8
8. Test
Target condition: SIS. Index test: Neer's sign (modified procedure)..
9
9. Test
Target condition: SIS. Index test: painful arc test (standard)..
10
10. Test
Target condition: SIS. Index test: passive horizontal adduction (modified interpretation)..
11
11. Test
Target condition: SIS. Index test: Speed's test (modified interpretation)..
12
12. Test
Target condition: SIS. Index test: Yergason's test (modified interpretation)..
13
13. Test
Target condition: SIS (SA‐SD bursitis). Index test: combination of Hawkins' test, Neer's sign, 'Yocum's (impingement) test' (overall criterion for +ve result not given)..
14
14. Test
Target condition: SIS versus internal impingement, differentiation. Index test: internal rotation resistance strength test (novel)..
15
15. Test
Target condition: rotator cuff, any disease of. Index test: relocation test for pain (Jobe 1989: standard)..
16
16. Test
Target condition: rotator cuff, any disease of. Index test: relocation test for pain (Jobe 1989: modified procedure)..
17
17. Test
Target condition: rotator cuff, FTT or PTT of. Index test: combination of Hawkins' test (modified interpretation) OR Neer's sign (modified procedure, modified interpretation) +ve..
18
18. Test
Target condition: rotator cuff, FTT or PTT of. Index test: combination of Hawkins' test (modified interpretation) AND Neer's sign (modified procedure,modified interpretation) +ve..
19
19. Test
Target condition: rotator cuff, FTT or PTT of. Index test: empty can test for pain ± weakness (modified interpretation)..
20
20. Test
Target condition: rotator cuff, FTT or PTT of. Index test: empty can test for pain OR weakness (ONE ONLY) (modified interpretation)..
21
21. Test
Target condition: rotator cuff, FTT or PTT of. Index test: empty can test for pain AND weakness (BOTH) (modified interpretation)..
22
22. Test
Target condition: rotator cuff, FTT or PTT of. Index test: empty can test for weakness ± pain (modified interpretation)..
23
23. Test
Target condition: rotator cuff, FTT or PTT of. Index test: full can test for pain ± weakness (modified interpretation)..
24
24. Test
Target condition: rotator cuff, FTT or PTT of. Index test: full can test for pain OR weakness (ONE ONLY) (modified interpretation)..
25
25. Test
Target condition: rotator cuff, FTT or PTT of. Index test: full can test for pain AND weakness (BOTH) (modified interpretation)..
26
26. Test
Target condition: rotator cuff, FTT or PTT of. Index test: full can test for weakness ± pain (standard)..
27
27. Test
Target condition: rotator cuff, FTT or PTT of. Index test: Hawkins' test (modified interpretation)..
28
28. Test
Target condition: rotator cuff, FTT or PTT of. Index test: 'Impingement sign' (no reference or details given)..
29
29. Test
Target condition: rotator cuff, FTT or PTT of. Index test: 'Impingement test' (no reference or details given)..
30
30. Test
Target condition: rotator cuff, FTT or PTT of. Index test: Neer's sign (modified procedure, modified interpretation)..
31
31. Test
Target condition: rotator cuff, PTT or tendinitis of. Index test: empty can test for pain WITHOUT weakness (modified interpretation)..
32
32. Test
Target condition: rotator cuff, FTT of. Index test: empty can test for pain ± weakness (modified interpretation)..
33
33. Test
Target condition: rotator cuff, FTT of. Index test: empty can test for pain OR weakness (ONE ONLY) (modified interpretation)..
34
34. Test
Target condition: rotator cuff, FTT of. Index test: empty can test for pain AND weakness (BOTH) (modified interpretation)..
35
35. Test
Target condition: rotator cuff, FTT of. Index test: empty can test for weakness ± pain (modified interpretation)..
36
36. Test
Target condition: rotator cuff, FTT of. Index test: full can test for pain ± weakness (modified interpretation)..
37
37. Test
Target condition: rotator cuff, FTT of. Index test: full can test for pain OR weakness (ONE ONLY) (modified interpretation)..
38
38. Test
Target condition: rotator cuff, FTT of. Index test: full can test for pain AND weakness (BOTH) (modified interpretation)..
39
39. Test
Target condition: rotator cuff, FTT of. Index test: full can test for weakness ± pain (modified interpretation)..
40
40. Test
Target condition: rotator cuff, FTT of. Index test: 'impingement sign' (no reference or details given)..
41
41. Test
Target condition: rotator cuff, FTT of. Index test: 'impingement test' (no reference or details given)..
42
42. Test
Target condition: rotator cuff, FTT of. Index test: rent test (standard)..
43
43. Test
Target condition: rotator cuff, FTT of, massive or large. Index test: empty can test for weakness ± pain (modified interpretation)..
44
44. Test
Target condition: rotator cuff, PTT of. Index test: 'Impingement sign' (no reference or details given)..
45
45. Test
Target condition: rotator cuff, PTT of. Index test: 'Impingement test' (no reference or details given)..
46
46. Test
Target condition: rotator cuff, postero‐superior (supraspinatus AND infraspinatus), FTT of. Index test: Gum‐turn test (novel)..
47
47. Test
Target condition: rotator cuff, postero‐superior, FTT or PTT of. Index test: drop sign (novel)..
48
48. Test
Target condition: rotator cuff, postero‐superior, FTT or PTT of. Index test: empty can test for weakness ± pain (modified interpretation)..
49
49. Test
Target condition: rotator cuff, postero‐superior, FTT or PTT of. Index test: external rotation lag sign (novel)..
50
50. Test
Target condition: rotator cuff, postero‐superior, FTT of. Index test: drop sign (modified interpretation)..
51
51. Test
Target condition: rotator cuff, postero‐superior, FTT of. Index test: external rotation lag sign (modified interpretation)..
52
52. Test
Target condition: rotator cuff, postero‐superior, FTT of. Index test: Gum‐turn test (novel)..
53
53. Test
Target condition: rotator cuff, FTT, multiple‐ versus single‐tendon. Index test: active abduction range (novel)..
54
54. Test
Target condition: supraspinatus, any disease of, including calcification. Index test: empty can test (no reference or details given)..
55
55. Test
Target condition: supraspinatus, FTT, degeneration or tendinitis,of. Index test: Hawkins' test (modified procedure, modified interpretation)..
56
56. Test
Target condition: supraspinatus, FTT, PTT or tendinitis,of. Index test: empty can test for pain AND/OR weakness (standard)..
57
57. Test
Target condition: supraspinatus, FTT or degeneration of. Index test: Hawkins' test (modified procedure, modified interpretation)..
58
58. Test
Target condition: supraspinatus, FTT or PTT of. Index test: empty can test for pain ± weakness (modified interpretation)..
59
59. Test
Target condition: supraspinatus, FTT or PTT of. Index test: empty can test for weakness ± pain (standard)..
60
60. Test
Target condition: supraspinatus, FTT or PTT of. Index test: empty can test for weakness (< grade 3) ± pain.(modified interpretation).
61
61. Test
Target condition: supraspinatus, FTT or PTT of. Index test: full can test for pain ± weakness (modified interpretation)..
62
62. Test
Target condition: supraspinatus, FTT or PTT of. Index test: full can test for weakness (< grade 3) ± pain (modified interpretation)..
63
63. Test
Target condition: supraspinatus, FTT or PTT of. Index test: full can test for weakness ± pain (standard)..
64
64. Test
Target condition: supraspinatus, FTT of. Index test: drop arm test (standard)..
65
65. Test
Target condition: supraspinatus, FTT of. Index test: empty can test for pain ± weakness (modified interpretation)..
66
66. Test
Target condition: supraspinatus, FTT of. Index test: empty can test for pain AND/OR weakness (modified interpretation)..
67
67. Test
Target condition: supraspinatus, FTT of. Index test: empty can test for weakness ± pain (standard)..
68
68. Test
Target condition: supraspinatus, FTT of. Index test: full can test for pain ± weakness (modified interpretation)..
69
69. Test
Target condition: supraspinatus, FTT of. Index test: full can test for pain AND/OR weakness (modified interpretation)..
70
70. Test
Target condition: supraspinatus, FTT of. Index test: full can test for weakness ± pain (standard)..
71
71. Test
Target condition: supraspinatus, FTT of. Index test: Gum‐turn test (novel)..
72
72. Test
Target condition: supraspinatus, FTT of. Index test: Hawkins' test (modified interpretation)..
73
73. Test
Target condition: supraspinatus, FTT of. Index test: Hawkins' test (modified procedure, modified interpretation)..
74
74. Test
Target condition: supraspinatus, FTT of. Index test: Neer's sign (modified interpretation)..
75
75. Test
Target condition: supraspinatus, FTT of. Index test: painful arc test (modified interpretation)..
76
76. Test
Target condition: supraspinatus, FTT of. Index test: passive horizontal adduction (standard)..
77
77. Test
Target condition: supraspinatus, FTT of. Index test: Speed's test (modified interpretation)..
78
78. Test
Target condition: supraspinatus, FTT of. Index test: Yergason's test (modified interpretation)..
79
79. Test
Target condition: supraspinatus, FTT of, full‐width. Index test: external rotation lag sign (standard)..
80
80. Test
Target condition: supraspinatus, isolated PTT of. Index test: external rotation lag sign (standard)..
81
81. Test
Target condition: supraspinatus, tendinitis of. Index test: empty can test for pain WITHOUT weakness (standard)..
82
82. Test
Target condition: infraspinatus, any disease of, including calcification. Index test: resisted lateral rotation from neutral rotation (no reference or details given)..
83
83. Test
Target condition: infraspinatus, FTT, PPT or tendinitis,of. Index test: Patte's test for pain AND/OR weakness (standard)..
84
84. Test
Target condition: infraspinatus, FTT or PTT of. Index test: Patte's test for weakness ± pain (standard)..
85
85. Test
Target condition: infraspinatus, FTT or PTT of. Index test: resisted lateral rotation from neutral rotation for weakness < grade 3 ± pain (modified interpretation)..
86
86. Test
Target condition: infraspinatus, tendinitis of. Index test: Patte's test for pain WITHOUT weakness (standard)..
87
87. Test
Target condition: subscapularis, any disease of, including calcification. Index test: resisted medial rotation from neutral rotation (no reference or details given)..
88
88. Test
Target condition: subscapularis, any tear or tendinitis of. Index test: combination of lift‐off test and resisted medial rotation from neutral rotation (overall criterion for +ve result not given)..
89
89. Test
Target condition: subscapularis, any tear of. Index test: bear‐hug test (novel).
90
90. Test
Target condition: subscapularis, any tear of. Index test: belly‐press test (standard).
91
91. Test
Target condition: subscapularis, any tear of. Index test: internal rotation lag sign (novel)..
92
92. Test
Target condition: subscapularis, any tear of. Index test: lift‐off test (Gerber 1991: modified interpretation)..
93
93. Test
Target condition: subscapularis, any tear of. Index test: lift‐off test (Gerber 1991: probably standard).
94
94. Test
Target condition: subscapularis, any tear of. Index test: Napoleon test (Burkhart 2002: standard)..
95
95. Test
Target condition: subscapularis, any tear of. Index test:: lift‐off test with force for weakness < grade 2 ± pain (modified procedure, modified interpretation)..
96
96. Test
Target condition: subscapularis, any tear of. Index test: combination of lift‐off test and resisted medial rotation from neutral rotation (overall criterion for +ve result not given)..
97
97. Test
Target condition: subscapularis, complete tear of. Index test: bear‐hug test (novel)..
98
98. Test
Target condition: subscapularis, complete tear of. Index test: belly‐press test (modified procedure)..
99
99. Test
Target condition: subscapularis, complete tear of. Index test: lift‐off test (Gerber 1991: modified interpretation)..
100
100. Test
Target condition: subscapularis, complete tear of. Index test: Napoleon test (Burkhart 2002: standard)..
101
101. Test
Target condition: subscapularis, FTT of. Index test: internal rotation lag sign (modified interpretation)..
102
102. Test
Target condition: subscapularis, partial tear of. Index test: bear‐hug test (novel)..
103
103. Test
Target condition: subscapularis, partial tear of. Index test: belly‐press test (modified procedure)..
104
104. Test
Target condition: subscapularis, partial tear of. Index test: lift‐off test (Gerber 1991: modified interpretation)..
105
105. Test
Target condition: subscapularis, partial tear of. Index test: Napoleon test (Burkhart 2002: standard)..
106
106. Test
Target condition: subscapularis, tendinitis of. Index test: combination of lift‐off test and resisted medial rotation from neutral rotation (overall criterion for +ve result not given)..
107
107. Test
Target condition: LHB, tear or tendinitis of. Index test: Speed's test (standard)..
108
108. Test
Target condition: LHB, tear or tendinitis of. Index test: active compression test (standard).
109
109. Test
Target condition: LHB, tear or tendinitis of. Index test: anterior slide test (modified procedure, modified interpretation)..
110
110. Test
Target condition: LHB, tear or tendinitis of. Index test: bear‐hug test (modified interpretation).
111
111. Test
Target condition: LHB, tear or tendinitis of. Index test: belly‐press test (standard).
112
112. Test
Target condition: LHB, tear or tendinitis of. Index test: modified dynamic labral shear (novel).
113
113. Test
Target condition: LHB, tear or tendinitis of. Index test: Speed's test (modified procedure).
114
114. Test
Target condition: LHB, tear or tendinitis of. Index test: upper‐cut test (novel).
115
115. Test
Target condition: LHB, tear or tendinitis of. Index test: Yergason's test (modified procedure).
116
116. Test
Target condition: LHB, tear or tendinitis of. Index test: combination of Yergason's test and Gilcreest's test (modified procedure, modified interpretation).(Overall criterion for +ve result not given.).
117
117. Test
Target condition: labrum, any tear of. Index test: active compression test (novel)..
118
118. Test
Target condition: labrum, any tear of. Index test: active compression test (modified interpretation)..
119
119. Test
Target condition: labrum, any tear,of. Index test: crank test (novel/standard)..
120
120. Test
Target condition: labrum, any tear,of. Index test: 'impingement sign' (no reference or details given)..
121
121. Test
Target condition: labrum, any tear,of. Index test: 'impingement test' (no reference or details given)..
122
122. Test
Target condition: labrum, any SLAP lesion of. Index test: active compression test (modified interpretation)..
123
123. Test
Target condition: labrum, any SLAP lesion of. Index test: anterior apprehension test at 90° for pain (Krishnan 2004: modified interpretation)..
124
124. Test
Target condition: labrum, any SLAP lesion,of. Index test: anterior release test (Gross 1997: modified interpretation)..
125
125. Test
Target condition: labrum, any SLAP lesion of. Index test: anterior slide test (modified procedure, modified interpretation)..
126
126. Test
Target condition: labrum, any SLAP lesion of. Index test: bear‐hug test (modified interpretation)..
127
127. Test
Target condition: labrum, any SLAP lesion of. Index test: belly‐press test (modified interpretation)..
128
128. Test
Target condition: labrum, any SLAP lesion of. Index test: crank test (Liu 1996b: modified procedure, modified interpretation)..
129
129. Test
Target condition: labrum, any SLAP lesion of. Index test: modified dynamic labral shear (novel)..
130
130. Test
Target condition: labrum, any SLAP lesion of. Index test: palpation for bicipital groove tenderness (modified interpretation)..
131
131. Test
Target condition: labrum, any SLAP lesion of. Index test: passive compression test (novel)..
132
132. Test
Target condition: labrum, any SLAP lesion of. Index test: Speed's test (modified procedure, modified interpretation)..
133
133. Test
Target condition: labrum, any SLAP lesion of. Index test: Speed's test (modified interpretation)..
134
134. Test
Target condition: labrum, any SLAP lesion of. Index test: upper cut test (novel)..
135
135. Test
Target condition: labrum, any SLAP lesion of. Index test: Yergason's test (modified interpretation)..
136
136. Test
Target condition: labrum, any SLAP lesion of. Index test: Yergason's test (modified procedure, modified interpretation)..
137
137. Test
Target condition: labrum, type II‐IV SLAP lesion of. Index test: active compression test (modified interpretation)..
138
138. Test
Target condition: labrum, type II‐IV SLAP lesion of. Index test: anterior slide test (modified procedure)..
139
139. Test
Target condition: labrum, type II‐IV SLAP lesion of. Index test: combination of active compression test (modified interpretation) OR passive distraction test (standard)..
140
140. Test
Target condition: labrum, type II‐IV SLAP lesion of. Index test: passive compression test (novel, modified interpretation)..
141
141. Test
Target condition: labrum, type II‐IV SLAP lesion of. Index test: passive distraction test (standard)..
142
142. Test
Target condition: labrum, type II SLAP lesion of. Index test: active compression test (modified interpretation 2)..
143
143. Test
Target condition: labrum, type II SLAP lesion of. Index test: active compression test (modified interpretation 1,2)..
144
144. Test
Target condition: labrum, type II SLAP lesion of. Index test: anterior apprehension test at 90° for pain OR apprehension (Rowe 1981: modified interpretation)..
145
145. Test
Target condition: labrum, type II SLAP lesion of. Index test: anterior slide test (modified interpretation)..
146
146. Test
Target condition: labrum, type II SLAP lesion of. Index test: biceps load test II (novel/standard)..
147
147. Test
Target condition: labrum, type II SLAP lesion of. Index test: compression‐rotation test (modified interpretation)..
148
148. Test
Target condition: labrum, type II SLAP lesion of. Index test: crank test (modified procedure, modified interpretation)..
149
149. Test
Target condition: labrum, type II SLAP lesion of. Index test: Hawkins' test (modified procedure, modified interpretation)..
150
150. Test
Target condition: labrum, type II SLAP lesion of. Index test: modified relocation test for posterosuperior glenoid impingement (modified interpretation)..
151
151. Test
Target condition: labrum, type II SLAP lesion of. Index test: Neer's sign (modified procedure, modified interpretation)..
152
152. Test
Target condition: labrum, type II SLAP lesion of. Index test: pain provocation test (modified interpretation)..
153
153. Test
Target condition: labrum, type II SLAP lesion of. Index test: palpation for bicipital groove tenderness (modified interpretation)..
154
154. Test
Target condition: labrum, type II SLAP lesion of. Index test: relocation test for pain OR apprehension (modified interpretation)..
155
155. Test
Target condition: labrum, type II SLAP lesion of. Index test: Speed's test (modified interpretation)..
156
156. Test
Target condition: labrum, type II SLAP lesion of. Index test: Speed's test (modified procedure, modified interpretation)..
157
157. Test
Target condition: labrum, type II SLAP lesion of. Index test: Whipple's test (modified interpretation)..
158
158. Test
Target condition: labrum, type II SLAP lesion of. Index test: Yergason's test (modified interpretation 2)..
159
159. Test
Target condition: labrum, type II SLAP lesion of. Index test: Yergason's test (modified interpretation 1,2)..
160
160. Test
Target condition: multiple (LHB tendinitis/LHB avulsion/SLAP lesion, any). Index test: Speed's test (modified procedure, modified interpretation 1)..
161
161. Test
Target condition: multiple (LHB lesion, any/type II or IV SLAP lesion). Index test: Speed's test (modified procedure, modified interpretation 1,2)..
162
162. Test
Target condition: multiple (LHB lesion, any/type II or IV SLAP lesion). Index test: Yergason's test (modified interpretation 1,2)..
163
163. Test
Target condition: multiple (SA‐SD bursitis/bursal side degeneration of supraspinatus ± other pathology of tendon or labrum ± instability). Index test: Empty can test (modified interpretation)..
164
164. Test
Target condition: multiple (SA‐SD bursitis/bursal side degeneration of supraspinatus ± other pathology of tendon or labrum ± instability). Index test: Hawkins' test (standard)..
165
165. Test
Target condition: multiple (SA‐SD bursitis/bursal side degeneration of supraspinatus ± other pathology of tendon or labrum ± instability). Index test: Neer's sign (modified procedure)..
166
166. Test
Target condition: multiple (SA‐SD bursitis/bursal side degeneration of supraspinatus ± other pathology of tendon or labrum ± instability). Index test: painful arc test (standard)..
167
167. Test
Target condition: multiple (SA‐SD bursitis/bursal side degeneration of supraspinatus ± other pathology of tendon or labrum ± instability) Index test: resisted lateral rotation from neutral rotation for weakness ± pain (modified interpretation 1,2)..
168
168. Test
Target condition: multiple (SA‐SD bursitis/bursal side degeneration of supraspinatus ± other pathology of tendon or labrum ± instability). Index test: combination of 3 or more tests +ve (see table 11)..
169
169. Test
Target condition: multiple (SIS/rotator cuff tendinitis or tear). Index test: Hawkins' test (modified interpretation)..
170
170. Test
Target condition: multiple (SIS/rotator cuff tendinitis or tear). Index test: Neer's sign (modified interpretation)..
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD007427

References

References to studies included in this review

Barth 2006 {published data only}
    1. Barth JR, Burkhart SS, Beer JF. The bear‐hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 2006;22(10):1076‐84. - PubMed
Bennett 1998 {published data only}
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Calis 2000 {published data only}
    1. Calis M, Akgun K, Birtane M, Karacan I, Calis H, Tuzun F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the Rheumatic Diseases 2000;59(1):44‐7. - PMC - PubMed
Castoldi 2009 {published data only}
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Frost 1999 {published data only}
    1. Frost P, Andersen JH, Lundorf E. Is supraspinatus pathology as defined by magnetic resonance imaging associated with clinical sign of shoulder impingement?. Journal of Shoulder & Elbow Surgery 1999;8(6):565‐8. - PubMed
Guanche 2003 {published data only}
    1. Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy 2003;19(5):517‐23. - PubMed
Gumina 2008 {published data only}
    1. Gumina S, Bertino A, Giorgio G, Postacchini F. A new test of resistance in the diagnosis of postero‐superior rotator cuff tears. Chirurgia Degli Organi di Movimento 2008;91(2):85‐6. - PubMed
Hertel 1996 {published data only}
    1. Hertel R, Ballmer FT, Lombert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. Journal of Shoulder and Elbow Surgery 1996;5(4):307‐13. - PubMed
Holtby 2004a {published data only}
    1. Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy 2004;20(3):231‐6. - PubMed
Holtby 2004b {published data only}
    1. Holtby R, Razmjou H. Validity of the supraspinatus test as a single clinical test in diagnosing patients with rotator cuff pathology. Journal of Orthopaedic & Sports Physical Therapy 2004;34(4):194‐200. - PubMed
Iagnocco 2003 {published data only}
    1. Iagnocco A, Coari G, Leone A, Valesini G. Sonographic study of painful shoulder. Clinical & Experimental Rheumatology 2003;21(1):355‐8. - PubMed
Itoi 1999 {published data only}
    1. Itoi E, Kido T, Sano A, Urayama M, Sato K. Which is more useful, the "full can test" or the "empty can test," in detecting the torn supraspinatus tendon?. American Journal of Sports Medicine 1999;27(1):65‐8. - PubMed
Itoi 2006 {published data only}
    1. Itoi E, Minagawa H, Yamamoto N, Seki N, Abe H. Are pain location and physical examinations useful in locating a tear site of the rotator cuff?. American Journal of Sports Medicine 2006;34(2):256‐64. - PubMed
Kibler 2009 {published data only}
    1. Kibler WB, Sciasca A, Hester P, Dome d, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. American Journal of Sports Medicine 2009;37(9):1840‐7. - PubMed
Kim 2001 {published data only}
    1. Kim S‐H, Ha K‐I, Ahn J‐H, Kim S‐H, Choi H‐J. Biceps Load Test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy 2001;17(2):160‐4. - PubMed
Kim 2006 {published data only}
    1. Kim E, Jeong HJ, Lee KW, Song JS. Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff. Acta Medica Okayama 2006;60(4):223‐8. - PubMed
Kim 2007b {published data only}
    1. Kim Y‐S, Kim J‐M, Ha K‐Y, Choy S, Joo M‐W, Chung Y‐G. The passive compression test: A new clinical test for superior labral tears of the shoulder. American Journal of Sports Medicine 2007;35(9):1489‐94. - PubMed
Liu 1996b {published data only}
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MacDonald 2000 {published data only}
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Michener 2009 {published and unpublished data}
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Miller 2008b {published data only}
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Naredo 2002 {published data only}
    1. Naredo E, Aguado P, Miguel E, Uson J, Mayordomo L, Gijon‐banos J, et al. Painful shoulder: comparison of physical examination and ultrasonographic findings. Annals of the Rheumatic Diseases 2002;61(2):132‐6. - PMC - PubMed
Norwood 1989 {published data only}
    1. Norwood LA, Barrack R, Jacobson KE. Clinical presentation of complete tears of the rotator cuff. Journal of Bone & Joint Surgery ‐ American Volume 1989;71(4):499‐505. - PubMed
O'Brien 1998 {published data only}
    1. O'Brien SJ, Pagnani MJ, Fealy S, McGrory JE, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. American Journal of Sports Medicine 1998;26(5):610‐3. - PubMed
Oh 2008 {published data only}
    1. Oh JH, Kim JY, Kim WS, Gong HS, Lee JH. The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. American Journal of Sports Medicine 2008;36(2):353‐9. - PubMed
Parentis 2006 {published data only}
    1. Parentis MA, Glousman RE, Mohr KS, Yocum LA. An evaluation of the provocative tests for superior labral anterior posterior lesions. American Journal of Sports Medicine 2006;34(2):265‐8. - PubMed
    1. Parentis MA, Mohr KJ, Elattrache NS. Disorders of the superior labrum: review and treatment guidelines. Clinical Orthopaedics & Related Research 2002;400:77‐87. - PubMed
Razmjou 2004 {published data only}
    1. Razmjou H, Holtby R, Myhr T. Pain provocative shoulder tests: reliability and validity of the impingement tests. Physiotherapy Canada 2004;56(4):229‐36.
Schlechter 2009 {published data only}
    1. Schlechter JA, Summa S, Rubin BD. The passive distraction test: a new diagnostic aid for clinically significant superior labral pathology. Arthroscopy 2009;25(12):1374‐9. - PubMed
Speer 1994 {published data only}
    1. Speer KP, Hannafin JA, Altchek DW, Warren RF. An evaluation of the shoulder relocation test. American Journal of Sports Medicine 1994;22(2):177‐83. - PubMed
Stetson 2002 {published data only}
    1. Stetson WB, Templin K. The crank test, the O'Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. American Journal of Sports Medicine 2002;30(6):806‐9. - PubMed
Suder 1994 {published data only}
    1. Suder PA, Hougaard K, Frich LH, Rasmussen OS, Lundorf E. Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases. Acta Orthopaedica Scandinavica 1994;65(3):339‐43. - PubMed
Wolf 2001 {published data only}
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Zaslav 2001 {published data only}
    1. Zaslav KR. Internal rotation resistance strength test: a new diagnostic test to differentiate intra‐articular pathology from outlet (Neer) impingement syndrome in the shoulder. Journal of Shoulder and Elbow Surgery 2001;10(1):23‐7. - PubMed

References to studies excluded from this review

Adolfsson 1991 {published data only}
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Altchek 1990 {published data only}
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Ansara 2006 {published data only}
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Ardic 2006 {published data only}
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Beaudreuil 2009 {published data only}
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Bedi 2008 {published data only}
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Berbig 1999 {published data only}
    1. Berbig R, Weishaupt D, Prim J, Shahin O. Primary anterior shoulder dislocation and rotator cuff tears. Journal of Shoulder and Elbow Surgery 1999;8(3):220‐5. - PubMed
Berg 1997 {published data only}
    1. Berg EE, Ciullo JV. The SLAP lesion: a cause of failure after distal clavicle resection. Arthroscopy 1997;13(1):85‐9. - PubMed
Berg 1998 {published data only}
    1. Berg EE, Ciullo JV. A clinical test for superior glenoid labral or 'SLAP' lesions. Clinical Journal of Sport Medicine 1998;8(2):121‐3. - PubMed
Bigliani 1997 {published data only}
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Birtane 2001 {published data only}
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Blair 1996 {published data only}
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Blevins 1996a {published data only}
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Blevins 1996b {published data only}
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Brasseur 2004 {published data only}
    1. Brasseur JL, Lucidarme O, Tardieu M, Tordeur M, Montalvan B, Parier J, et al. Ultrasonographic rotator‐cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings. European Radiology 2004;14(5):857‐64. - PubMed
Bron 2007 {published data only}
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Brownlow 2009 {published data only}
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Brox 2003 {published data only}
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Bryant 2002 {published data only}
    1. Bryant L, Shnier R, Bryant C, Murrell GA. A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. Journal of Shoulder & Elbow Surgery 2002;11(3):219‐24. - PubMed
Buchberger 1999 {published data only}
    1. Buchberger D J. Introduction of a new physical examination procedure for the differentiation of acromioclavicular joint lesions and subacromial impingement. Journal of Manipulative and Physiological Therapeutics 1999;22(5):316‐21. - PubMed
Burbank 2007 {published data only}
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Burkhart 2000 {published data only}
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Burkhart 2002 {published data only}
    1. Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy 18;5:454‐63. - PubMed
Burkhart 2003 {published data only}
    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 2003;19(5):531‐9. - PubMed
Burkhart 2008 {published data only}
    1. Burkhart SS, Ochoa Jr. Subscapularis tendon tears: Diagnosis and treatment strategies. Current Orthopaedic Practice 2008;19(5):542‐7.
Callanan 2001 {published data only}
    1. Callanan M, Tzannes A, Hayes K, Paxinos A, Walton J, Murrell GA. Shoulder instability. Diagnosis and management. Australian Family Physician 2001;30(7):655‐61. - PubMed
Calvert 2009 {published data only}
    1. Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior posterior shoulder tears are clinically limited and invalid: a diagnostic systematic review. Journal of Clinical Epidemiology 2009;62(5):558‐63. - PubMed
Chronopoulos 2004 {published data only}
    1. Chronopoulos E, Kim TK, Park HB, Ashenbrenner D, McFarland EG. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. American Journal of Sports Medicine 2004;32(3):655‐61. - PubMed
Cools 2008 {published data only}
    1. Cools AM, Cambier D, Witvrouw EE. Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. British Journal of Sports Medicine 2008;42(8):628‐35. - PubMed
Corso 1995 {published data only}
    1. Corso G. Impingement relief test: an adjunctive procedure to traditional assessment of shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy 1995;22(5):183‐92. - PubMed
Crenshaw 1966 {published data only}
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Cullen 2007 {published data only}
    1. Cullen DM, Breidahl WH, Janes GC. Diagnostic accuracy of shoulder ultrasound performed by a single operator. Australasian Radiology 2007;51(3):226‐9. - PubMed
D'Alessandro 2000 {published data only}
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Dessaur 2008 {published data only}
    1. Dessaur WA, Magarey ME. Diagnostic accuracy of clinical tests for superior labral anterior posterior lesions: a systematic review. Journal of Orthopaedic & Sports Physical Therapy 2008;38(6):341‐52. - PubMed
Deutsch 1997 {published data only}
    1. Deutsch A, Altcheck DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. American Journal of Sports Medicine 1997;25(1):13‐22. - PubMed
Diehr 2006 {published data only}
    1. Diehr S, Ison D, Jamieson B, Oh R. Clinical inquiries. What is the best way to diagnose a suspected rotator cuff tear?. Journal of Family Practice 2006;55(7):621‐4. - PubMed
Dinnes 2003a {published data only}
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Ebinger 2008 {published data only}
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El Dalati 2005 {published data only}
    1. Dalati G, Castellarin G, Martone E, Ricci M, Vecchini E, Caffarri S, et al. Standard sonography and arthrosonography in the study of rotator cuff tears. Radiologia Medica 2005;110(5‐6):616‐22. - PubMed
Fodor 2009 {published data only}
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Fukuda 1996 {published data only}
    1. Fukuda H, Hamada K, Nakajima T, Yamada N, Tomonaga A, Goto M. Partial‐thickness tears of the rotator cuff. A clinicopathological review based on 66 surgically verified cases. International Orthopaedics 1996;20(4):257‐65. - PubMed
Gartsman 2000 {published data only}
    1. Gartsman GM. (iii) Partial thickness rotator cuff tears ‐ evaluation and treatment. Current Orthopaedics 2000;14(3):167‐72.
Gerber 1985 {published data only}
    1. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. Journal of Bone & Joint Surgery ‐ British Volume 1985;67(5):703‐8. - PubMed
Gerber 1991 {published data only}
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Gerber 1996 {published data only}
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Gerber 2000 {published data only}
    1. Gerber C, Sebesta A. Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. Journal of Shoulder & Elbow Surgery 2000;9(6):483‐90. - PubMed
Giombini 1997 {published data only}
    1. Giombini A, Rossi F, Pettrone FA, Dragoni S. Posterosuperior glenoid rim impingement as a cause of shoulder pain in top level waterpolo players. Journal of Sports Medicine & Physical Fitness 1997;37(4):273‐8. - PubMed
Gschwend 1988 {published data only}
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Hagemann 2004 {published data only}
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Halbrecht 1999 {published data only}
    1. Halbrecht JT, Tirman P. Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy 1999;15(3):253‐8. - PubMed
Hammer 2003 {published data only}
    1. Hammer W. An excellent test for a SLAP Lesion. Dynamic Chiropractic 2003;21(19):1‐3.
Hamner 2000 {published data only}
    1. Hamner DL, Pink MM, Jobe FW. A modification of the relocation test: arthroscopic findings associated with a positive test. Journal of Shoulder & Elbow Surgery 2000;9(4):263‐7. - PubMed
    1. Kolbel R. Modification of the relocation test: arthroscopic findings associated with a positive test [comment]. Journal of Shoulder & Elbow Surgery 2001;10(5):497‐8. - PubMed
Handelberg 1998 {published data only}
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Hawkins 1980 {published data only}
    1. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. American Journal of Sports Medicine 1980;8(3):151‐8. - PubMed
Hayes 2003 {published data only}
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Hegedus 2008 {published data only}
    1. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT III, et al. Physical examination tests of the shoulder: a systematic review with meta‐analysis of individual tests. British Journal of Sports Medicine 2008;42(2):80‐92. - PubMed
Heyworth 2009 {published data only}
    1. Heyworth BE, Williams RJ III. Internal impingement of the shoulder. American Journal of Sports Medicine 2009;37(5):1024‐37. - PubMed
Hughes 2008 {published data only}
    1. Hughes PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Australian Journal of Physiotherapy 2008;54(3):159‐70. - PubMed
Hurschler 2004 {published data only}
    1. Hertel R. Lag signs [comment]. Journal of Shoulder & Elbow Surgery 2005;14(3):343‐4. - PubMed
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Jee 2001 {published data only}
    1. Jee WH, McCauley TR, Katz lD, Matheny JM, Ruwe PA, Daigneault JP. Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis. Radiology 2001;218(1):127‐32. - PubMed
Jobe 1997 {published data only}
    1. Jobe CM. Superior glenoid impingement. Orthopaedic Clinics of North America 1997;28(2):137‐43. - PubMed
Jobe 2000 {published data only}
    1. Jobe CM, Coen MJ, Screnar P. Evaluation of impingement syndromes in the overhead‐throwing athlete. Journal of Athletic Training 2000;35(3):293‐9. - PMC - PubMed
Johansson 2009 {published data only}
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Jones 2007 {published data only}
    1. Jones GL, Galluch DB. Clinical assessment of superior glenoid labral lesions: a systematic review. Clinical Orthopaedics & Related Research 2007;455:45‐51. - PubMed
Keener 2009 {published data only}
    1. Keener JD, Brophy RH. Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment. Journal of the American Academy of Orthopaedic Surgeons 2009;17(10):627‐37. - PubMed
Kibler 1995 {published data only}
    1. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy 1995;11(3):296‐300. - PubMed
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Kibler 2006a {published data only}
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Kibler 2006b {published data only}
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Kim 1999 {published data only}
    1. Kim S‐H, Ha K‐I, Han K‐Y. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. American Journal of Sports Medicine 1999;27(3):300‐3. - PubMed
Kim 2004b {published data only}
    1. Kim S‐H, Park J‐H, Park J‐S, Oh I. Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. American Journal of Sports Medicine 2004;32(8):1849‐55. - PubMed
Kim 2005 {published data only}
    1. Kim SH, Park JS, Jeong WK, Shin SK. The Kim test: a novel test for posteroinferior labral lesion of the shoulder‐‐a comparison to the jerk test. American Journal of Sports Medicine 2005;33(8):1188‐92. - PubMed
Kim 2007a {published data only}
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Kim 2009 {published data only}
    1. Kim HM, Teefey SA, Zelig A, Galatz LM, Keener JD, Yamaguchi K. Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. Journal of Bone & Joint Surgery ‐ American Volume 2009;91(2):289‐96. - PMC - PubMed
Kirkley 2002 {published data only}
    1. Kirkley A, Litchfield RB, Jackowski DM, Lo IK. The use of the impingement test as a predictor of outcome following subacromial decompression for rotator cuff tendinosis. Arthroscopy 2002;18(1):8‐15. - PubMed
Koester 2005 {published data only}
    1. Koester MC, George MS, Kuhn JE. Shoulder impingement syndrome. American Journal of Medicine 2005;118(5):452‐5. - PubMed
Lafosse 2007 {published data only}
    1. Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B. Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 2007;23(1):73‐80. - PubMed
Le Huec 1996 {published data only}
    1. Huec JC, Schaeverbeke T, Moinard M, Kind M, Diard F, Dehais J, et al. Traumatic tear of the rotator interval. Journal of Shoulder & Elbow Surgery 1996;5(1):41‐6. - PubMed
Leroux 1995 {published data only}
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Lewis 2005 {published data only}
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McFarland 1999 {published data only}
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Mirkovic 2005 {published data only}
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Neer 1972 {published data only}
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Odom 2001 {published data only}
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Pandya 2008 {published data only}
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Perez‐Palomares 2009 {published data only}
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Piasecki 2008 {published data only}
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Pisan 2000 {published data only}
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Polimeni 2003 {published data only}
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Polsky 2006 {published data only}
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Pugh 2009 {published data only}
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Rao 2003 {published data only}
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Razmjou 2006 {published data only}
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Read 1998 {published data only}
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Rhee 2005a {published data only}
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Sandenbergh 2006 {published data only}
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Savoie 2001 {published data only}
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References to studies awaiting assessment

Gill 2007 {published data only}
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References to other published versions of this review

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