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Observational Study
. 2025 Jun 3;26(1):546.
doi: 10.1186/s12891-025-08754-1.

Physical examination tests in the acute phase of shoulder injuries with negative radiographs: a diagnostic accuracy study

Martine Enger  1   2 , Malte Schmidt  3 , Lars Nordsletten  3   4 , Stefan Moosmayer  5 , Are Hugo Pripp  6 , Knut Melhuus  3 , Jens Ivar Brox  4   7
Affiliations
Observational Study

Physical examination tests in the acute phase of shoulder injuries with negative radiographs: a diagnostic accuracy study

Martine Enger et al. BMC Musculoskelet Disord. .

Abstract

Background: Rotator cuff tears may easily be missed in patients with acute shoulder trauma. The evidence in support of shoulder physical examination tests has been considered insufficient in reviews and meta-analyses. The purpose of this study was to explore whether physical examination tests can effectively predict or rule out acute full-thickness rotator cuff tears in soft tissue shoulder injuries in emergency departments and primary health care.

Methods: In a combined primary care walk-in clinic and secondary care orthopaedic emergency department, 120 consecutive patients aged ≥ 40 years with acute shoulder injury without fracture on plain x-rays were enrolled prospectively at the first follow-up within three weeks of the injury. Thirteen physical examination tests and ultrasound screening as reference standard, were performed blinded to each other.

Results: The median age was 55 years, 51% were female. The prevalence of the target condition rotator cuff full-thickness tear and/or occult fracture of the insertion was 38% (n = 46; 38 tears and 8 occult avulsion fractures). Almost all tears involved the supraspinatus tendon (n = 36). The highest test accuracy was observed for the inability to abduct above 90°, resisted abduction pain and external rotation strength. The sensitivity, specificity and diagnostic odds ratio of the inability to abduct the arm above 90 ° was 84% (95% CI 69-93), 71% (95% CI 59-82) and 12.9 (95% CI 4.8-34.2), respectively, and 66% (51-80), 86% (77-93) and 12.4 (5.0-30.8) for external rotation strength assessed by the small finger test. Combining the inability to abduct above 90° and weakness in external rotation improved the sensitivity to above 90% and the diagnostic odds ratio to above 22, but specificity decreased.

Conclusions: The present study suggests that two simple tests, the inability to abduct above 90° and weakness in external rotation may effectively predict full-thickness tears of the supra- and infraspinatus and/or occult fracture at their insertion in the acute phase of soft tissue shoulder injuries. The test combination may be useful for selecting patients for advanced imaging and for diagnostic purposes when such imaging is not available.

Trial registration: The Norwegian Regional Ethics Committee South East (2015/195) on 24th March 2015, and retrospectively registered on ClinicalTrials.gov (NCT02644564) on 31st December 2015.

Keywords: Acute shoulder injury; Diagnostic accuracy; Physical examination; Rotator cuff; Shoulder.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was registered in and approved by the Norwegian Regional Ethics Committee South East (2015/195) and performed in accordance with the Helsinki declaration. Written informed consent was obtained from all participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of participants with inclusion and exclusion criteria
Fig. 2
Fig. 2
Receiver Operating Characteristic (ROC) curve for reduced abduction and target condition supraspinatus full-thickness tear with or without involvement of infraspinatus and/or avulsion fracture at insertion site. Area under curve (AUC) was 0.83
See this image and copyright information in PMC

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References

    1. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998;57(11):649–55. - PMC - PubMed
    1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73–81. - PubMed
    1. Engebretsen KB, Grotle M, Natvig B. Patterns of shoulder pain during a 14-year follow-up: results from a longitudinal population study in Norway. Shoulder Elb. 2015;7(1):49–59. - PMC - PubMed
    1. Ostor AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology (Oxford). 2005;44(6):800–5. - PubMed
    1. Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch orthopaedic association. Acta Orthop. 2014;85(3):314–22. - PMC - PubMed

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