Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Dec 19;25(1):1028.
doi: 10.1186/s12891-024-08144-z.

Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis

Qianzi Zhao  1 , Preethika Palani  1 , Nadine S Kassab  1 , Milan Terzic  1 , Monika Olejnik  1 , Sichao Wang  2 , Yma Tomassini-Lopez  1 , Corey Dean  1 , Richard A Shellenberger  3
Affiliations
Meta-Analysis

Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis

Qianzi Zhao et al. BMC Musculoskelet Disord. .

Abstract

Introduction: Shoulder pain represents a common patient complaint evaluated in a primary care setting. Approximately two thirds of these patients have rotator cuff injuries, with rotator cuff tears (RCTs) and subacromial impingement syndrome (SIS) accounting for a majority of causes. An accurate and efficient diagnostic strategy focused on physical examination findings may lead to improved outcomes and less functional disability.

Objective: To identify the most accurate physical examination tests for the diagnosis of RCT and SIS, we performed a systematic review and meta-analysis.

Methods: The database for our systematic review was compiled by using keywords and common indexing strategies to search PubMed, Ovid MEDLINE, Embase and the Cochrane Library from January 1, 1980, to March 15, 2024. Included studies evaluated a physical examination being performed prior to a reference standard diagnostic test for either RCT or SIS. Data was extracted in dual fashion and meta-analyses were performed regarding physical examination tests identified in our included studies.

Results: A total of twenty studies, which include 3,438 patients, met our inclusion criteria and had data extracted for statistical analysis. Data was adequate to perform meta-analyses on ten physical examination tests for RCT and five physical examination tests for SIS. There were six physical examination tests which had significant diagnostic odds ratios (DORs) when used in the diagnostic evaluation of suspected RCT, with the External Rotation Lag Sign at 90 Degrees having the highest magnitude of significance (DOR, 12.70; 95% CI, 3.68 - 43.86; P < .0001). Four physical examination tests had significant DORs for physical examination tests when used in the diagnostic evaluation of SIS, with the Yergason's Test having the highest magnitude of significance (DOR, 4.71; 95% CI; 2.16 - 10.32; P = .0001).

Conclusion: We present a large body of low-quality evidence for the diagnostic accuracies of physical examination tests for the identification of both RCT and SIS. We have identified novel data for the accuracy of the External Rotation Lag Sign at 90 Degrees and the Internal Rotation Lag Sign that have high to moderate diagnostic accuracy for ruling in tears of the rotator cuff.

Keywords: Clinical diagnosis; Evidence-based medicine; Meta-analysis; Physical examination; Rotator cuff tear; Subacromial impingement syndrome.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate:: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow diagram
Fig. 2
Fig. 2
DOR Forest plots for tests to diagnose rotator cuff tears
Fig. 3
Fig. 3
DOR Forest Plot for physical examination tests to diagnose subacromial impingement syndrome
See this image and copyright information in PMC

References

    1. Garfin SR, Andersson G, Gronblad M, Rydevik B. The bone and joint decade, 2000–2010, for prevention and treatment of musculoskeletal disorders. Spine. 1999;24(11):1055–7. - PubMed
    1. Bot SD, van der Waal JM, Terwee CB, et al. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis. 2005;64(1):118–23. - PMC - PubMed
    1. Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016;316(24):2627–46. - PMC - PubMed
    1. Kuijpers T, van der Windt D, van der Heijden G, Bouter LM. Systematic review of prognostic cohort studies on shoulder disorders. Pain. 2004;109(3):420–31. - PubMed
    1. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124–8. - PMC - PubMed

MeSH terms

LinkOut - more resources