Diagnostic Performance of Clinical Tests in Patients with Shoulder Pain

Abstract

Objective: This study aimed to investigate the diagnostic performance of clinical tests applied to patients with shoulder pain at a physical therapy outpatient clinic. Magnetic resonance imaging (MRI) findings were the major determinants to evaluate the accuracy of the clinical tests. Also, the relationship between the MRI findings and the pain and functional status of the shoulder were evaluated. Material and Methods: Seventy-six patients, referred to a physical therapy outpatient clinic with shoulder pain, were included in the study. Physical examination of all patients and specific clinical tests were performed for different shoulder pathologies. Pain levels of patients were evaluated with the visual analog scale and functional status of the shoulder with the Shoulder Disability Questionnaire. All patients were evaluated with MRI. Sensitivity, specificity, and positive and negative predictive values of the clinical tests were evaluated on the basis of the MRI findings. Results: The sensitivity of the tests evaluating impingement and rotator cuff pathologies was found to be high, but specificity was low. Diagnostic performance of the drop arm test to determine the supraspinatus ruptures; Yocum test to determine the subacromial and subdeltoid effusion; Patte test and external rotation lag sign to determine infraspinatus tendon pathologies; speed test to determine biceps pathologies; and horizontal adduction test and painful arc test to determine acromioclavicular joint pathologies were found to be statistically significant. In this study, the severity of pain and shoulder pathologies showed no statistically significant correlation. In terms of functional status, high scores were achieved only in the bicipital tendinitis group. Conclusion: MRI findings show that patients with shoulder pain may have multiple pathological lesions. Despite the coexistence of multiple pathologies and low specificity of clinical tests, clinical tests evaluating shoulder pathologies have great importance in directing the clinicians to diagnose and plan treatments because of high sensitivity.