THE VALUE OF CLINICAL SHOULDER EXAMINATIO N IN COMPARISON WITH ARTHROSCOPY - A PROSPECTIVE-STUDY

The results of clinical shoulder examination including 20 special test s were compared with subsequent arthroscopic findings in 45 patients. The sensitivity of the clinical diagnosis was 73%. Impingement syndrom e was correctly diagnosed in 19 of 22 cases (86%), rotator cuff tears in 7 of 9 cases (78%). The highest sensitivity for stage 11 impingemen t was found for the supraspinatus test (85%) and the lift-up test (92% ); the sensitivity of these tests for rotator cuff tears was 100% and 89% respectively. Differentiation between impingement syndrome with an d without rotator cuff tear by one of these tests alone was not possib le because of their low positive predictive values (26% and 56%). In c ontrast, in 90% of patients with negative rotator tests the rotator cu ff was complete, while the negative predictive value of the supraspina tus test was 100%. Instability was confirmed in only 53% of cases; the Leffert test had the highest positive predictive value (73%). In conc lusion, the clinical diagnosis of a shoulder lesion cannot reliably be achieved by single tests; rather overall evaluation by an experienced clinician is necessary.