Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Accuracy of Physical Examination in the Evaluation of Subacromial Impingement Syndrome
Silva, Lucía, Andreu, José-Luis, Munoz, Pilar, Oton, Teresa, Prada, Alejandro, Campos, José, Fernandez-Castro, Mónica
Shoulder pain due to subacromial impingement syndrome (SIS) is a common presenting complaint in rheumatology units. Physical examination (PE) of the shoulder includes several manoeuvres that explore subacromial space (SAS). High resolution ultrasonography (HRUS) has been advocated as a precise tool in the diagnosis of painful shoulder since it can evaluate the dynamic signs of impingement. The objective of this study is to compare PE findings with HRUS changes of subacromial space in patients with painful shoulder.
Consecutive patients with painful shoulder referred to our unit were included in the study. After obtaining a signed informed consent, in the same day, a pre-defined physical examination was done separately by two rheumatologists, and a HRUS examination (GE Logic-5 Pro) was carried out by a third rheumatologist, blinded for the clinical findings. Sensitivity, specificity, positive and negative predictive values, and precision of the different PE manoeuvres for the diagnosis SAS pathology were calculated.
Fourteen men and sixteen women were included. Mean ± SD age was 54.87 ± 13.8 years and the median duration of symptoms was 97.5 days. Sensitivity for Neer's manoeuvre was 100% and precision was 41%. Hawkins' test achieved a sensitivity of 67% and a precision of 34%. For Yocum's manoeuvre, sensitivity was 67% and precision 31%. For impingement manoeuvre values were: sensitivity, 67% and precision, 24%. Jobe's manoeuvre obtained a sensitivity of 100% and a precision of 38%. For Patte's manoeuvre sensitivity was 100% and precision 59%; and for resisted abduction 33% and 31% respectively. No test obtained a high positive predictive value for the diagnosis of SIS, although Neer, Jobe and Patte manoeuvres had a negative predictive value of 100%.
Most of PE manoeuvres detect reasonably well subacromial impingement of the shoulder, although only Patte manoeuvre has an acceptable accuracy.
To cite this abstract, please use the following information:
Silva, Lucía, Andreu, José-Luis, Munoz, Pilar, Oton, Teresa, Prada, Alejandro, Campos, José, et al; Accuracy of Physical Examination in the Evaluation of Subacromial Impingement Syndrome [abstract]. Arthritis Rheum 2009;60 Suppl 10 :83