D. Litaker et al., Returning to the bedside: Using the history and physical examination to identify rotator cuff tears, J AM GER SO, 48(12), 2000, pp. 1633-1637
Citations number
28
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
OBJECTIVES: To determine the value of elements of the bedside history and p
hysical examination in predicting arthrography results in older patients wi
th suspected rotator cuff tear (RCT).
DESIGN: Retrospective chart review
SETTING: Orthopedic practice limited to disorders of the shoulder
PARTICIPANTS: 448 consecutive patients with suspected RCT referred for arth
rography over a 4-year period
MAIN OUTCOME MEASURE: Presence of partial or complete RCT on arthrogram
RESULTS: 301 patients (67.2%) had evidence of complete or partial RCT. Clin
ical findings in the univariate analysis most closely associated with rotat
or cuff tear included infra- and supraspinatus atrophy (P < .001), weakness
with either elevation (P < .001) or external rotation (P < .001), are of p
ain (P = .004), and impingement sign (P = .01). Stepwise logistic regressio
n based on a derivation dataset (n = 191) showed that weakness with externa
l rotation (Adjusted Odds Ratio (AOR) 6.96 (3.09, 13.03)), age <greater tha
n or equal to> 55 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004,
7.39)) best predicted the presence of RCT. A five-point scoring system dev
eloped from this model was applied in the remaining patient sample (n = 214
) to test validity. No significant differences in performance were noted us
ing ROC curve comparison. Using likelihood ratios, a clinical score = 4 was
superior in predicting RCT tu the diagnostic prediction of an expert clini
cian. This score had specificity equivalent to magnetic resonance imaging o
r ultrasonography in diagnosis of RCT.
CONCLUSIONS: The presence of three simple features in the history and physi
cal examination of the shoulder can identify RCT efficiently. This approach
offers a valuable strategy to diagnosis at the bedside without compromisin
g sensitivity or specificity.