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Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff
BACKGROUND: Currently, clinical physical examination maneuvers alone provide variable reliability in diagnosing full-thickness rotator cuff tears (RCTs). PURPOSE: To assess the diagnostic accuracy of the scapular retraction test (SRT) to predict full-thickness RCTs. STUDY DESIGN: Cohort study (diagn...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172943/ https://www.ncbi.nlm.nih.gov/pubmed/30302349 http://dx.doi.org/10.1177/2325967118799308 |
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author | Khazzam, Michael Gates, Stephen T. Tisano, Breann K. Kukowski, Nathan |
author_facet | Khazzam, Michael Gates, Stephen T. Tisano, Breann K. Kukowski, Nathan |
author_sort | Khazzam, Michael |
collection | PubMed |
description | BACKGROUND: Currently, clinical physical examination maneuvers alone provide variable reliability in diagnosing full-thickness rotator cuff tears (RCTs). PURPOSE: To assess the diagnostic accuracy of the scapular retraction test (SRT) to predict full-thickness RCTs. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A total of 331 patients were prospectively evaluated in this cohort study. SRT was performed to assess the status of the rotator cuff. A positive SRT indicates an intact rotator cuff, and a negative SRT indicates a full-thickness RCT. Magnetic resonance imaging (MRI) was used as the gold standard. The examiner was blinded to the results until completing the physical examination. Statistical analysis was performed to assess the sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratios of the SRT. RESULTS: The prevalence of full-thickness RCTs diagnosed on MRI was 54.4% (180 of 331). Among the 180 patients with an MRI-confirmed full-thickness RCT, the SRT was negative for 147. Of 150 patients with an intact rotator cuff by MRI, 122 had a positive SRT. In diagnosing full-thickness RCTs, the SRT had a sensitivity of 81.7% (95% CI, 77.2%-85.4%), specificity of 80.8% (95% CI, 75.5%-85.3%), and accuracy 81.3%. The positive predictive value was 83.5% (95% CI, 78.9%-87.4%); the negative predictive value, 78.7% (95% CI, 73.5%-83.1%); the positive likelihood ratio, 4.3 (95% CI, 3.1-5.8); the negative likelihood ratio, 0.23 (95% CI, 0.17-0.30); and the diagnostic odds ratio, 18.7 (95% CI, 10.4-34.0). CONCLUSION: The results of this diagnostic study indicate that the SRT can accurately be used to clinically assess the status of the rotator cuff. This physical examination maneuver was found to be accurate, sensitive, and specific in diagnosing full-thickness RCTs. Additionally, our results indicate that it is equally as accurate to predict an intact rotator cuff tendon. Providing an accurate, reliable, and reproducible physical examination test will allow clinicians to diagnosis the integrity of the rotator cuff and will help guide treatment recommendations. |
format | Online Article Text |
id | pubmed-6172943 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-61729432018-10-09 Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff Khazzam, Michael Gates, Stephen T. Tisano, Breann K. Kukowski, Nathan Orthop J Sports Med Article BACKGROUND: Currently, clinical physical examination maneuvers alone provide variable reliability in diagnosing full-thickness rotator cuff tears (RCTs). PURPOSE: To assess the diagnostic accuracy of the scapular retraction test (SRT) to predict full-thickness RCTs. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A total of 331 patients were prospectively evaluated in this cohort study. SRT was performed to assess the status of the rotator cuff. A positive SRT indicates an intact rotator cuff, and a negative SRT indicates a full-thickness RCT. Magnetic resonance imaging (MRI) was used as the gold standard. The examiner was blinded to the results until completing the physical examination. Statistical analysis was performed to assess the sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratios of the SRT. RESULTS: The prevalence of full-thickness RCTs diagnosed on MRI was 54.4% (180 of 331). Among the 180 patients with an MRI-confirmed full-thickness RCT, the SRT was negative for 147. Of 150 patients with an intact rotator cuff by MRI, 122 had a positive SRT. In diagnosing full-thickness RCTs, the SRT had a sensitivity of 81.7% (95% CI, 77.2%-85.4%), specificity of 80.8% (95% CI, 75.5%-85.3%), and accuracy 81.3%. The positive predictive value was 83.5% (95% CI, 78.9%-87.4%); the negative predictive value, 78.7% (95% CI, 73.5%-83.1%); the positive likelihood ratio, 4.3 (95% CI, 3.1-5.8); the negative likelihood ratio, 0.23 (95% CI, 0.17-0.30); and the diagnostic odds ratio, 18.7 (95% CI, 10.4-34.0). CONCLUSION: The results of this diagnostic study indicate that the SRT can accurately be used to clinically assess the status of the rotator cuff. This physical examination maneuver was found to be accurate, sensitive, and specific in diagnosing full-thickness RCTs. Additionally, our results indicate that it is equally as accurate to predict an intact rotator cuff tendon. Providing an accurate, reliable, and reproducible physical examination test will allow clinicians to diagnosis the integrity of the rotator cuff and will help guide treatment recommendations. SAGE Publications 2018-10-04 /pmc/articles/PMC6172943/ /pubmed/30302349 http://dx.doi.org/10.1177/2325967118799308 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Khazzam, Michael Gates, Stephen T. Tisano, Breann K. Kukowski, Nathan Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff |
title | Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff |
title_full | Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff |
title_fullStr | Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff |
title_full_unstemmed | Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff |
title_short | Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff |
title_sort | diagnostic accuracy of the scapular retraction test in assessing the status of the rotator cuff |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172943/ https://www.ncbi.nlm.nih.gov/pubmed/30302349 http://dx.doi.org/10.1177/2325967118799308 |
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