Correlation between physical examination and intraoperative findings in shoulder disease treated by arthroscopy. Statistical analysis of 150 patients

• Published in: Revista española de cirugía ortopédica y traumatología 2016-09, Vol.60 (5), p.306-314
• Main Authors: García Parra, P, Anaya Rojas, M, Jiménez Bravo, B, González Oria, M O, Lisbona Muñoz, M, Gil Álvarez, J J, Cano Luis, P
• Format: Article
• Language: eng ; spa
• Subjects: Adult; Aged; Aged, 80 and over; Arthroscopy; Female; Humans; Joint Diseases - diagnosis; Joint Diseases - surgery; Longitudinal Studies; Male; Middle Aged; Physical Examination; Predictive Value of Tests; Retrospective Studies; Shoulder Injuries - diagnosis; Shoulder Injuries - surgery; Shoulder Joint - surgery
• ISSN: 1988-8856
• DOI: 10.1016/j.recot.2016.05.002

Only a few clinical exploratory manoeuvres are truly discriminatory and useful in shoulder disease. The aim of this study is to correlate the physical examination results of the shoulder with the true diagnosis found by arthroscopy. A retrospective case series of 150 patients with the most common surgical conditions of the shoulder. Data were collected on the suspicion of each pathology, the physical examination of the patient, and the actual discovery of the disease during arthroscopic surgery. The Bankart examination manoeuvres of the lesion show the best results, with a 92.1% positive prediction value (PPV), a 99.1% negative predictive value (NPV), followed by the impingement syndrome, with a PPV of 94.4%, and total cuff rupture with a PPV of 92.3%.Exploration of the superior labrum anterior to posterior (SLAP) lesion had an NPV of 99.1%. Physical examination is sufficient to diagnose or rule out Bankart. A positive physical examination provides the complete rupture of the rotator cuff, and requires further studies. The patients suspected of subacromial syndrome only need an NMR if the physical tests are negative. The conclusions drawn from this work can have a significant impact on both cost savings (by reducing forward tests), and saving time in certain cases in which, after appropriate physical examination, surgery may be indicated without losing time in intermediate steps.