Reliability and Diagnostic Accuracy of History and Physical Examination for Diagnosing Glenoid Labral Tears

• Published in: The American journal of sports medicine 2008-01, Vol.36 (1), p.162-168
• Main Authors: Walsworth, Matthew K., Doukas, William C., Murphy, Kevin P., Mielcarek, Billie J., Michener, Lori A.
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Adult; Aged; Aged, 80 and over; Arm Injuries - diagnosis; Arm Injuries - physiopathology; Arthroscopy; Biological and medical sciences; Care and treatment; Cartilage, Articular - injuries; Cartilage, Articular - pathology; Cartilage, Articular - physiopathology; Diagnosis; Endoscopic surgery; Endoscopy; Female; Fibrocartilage - injuries; Fibrocartilage - pathology; Fibrocartilage - physiopathology; Fundamental and applied biological sciences. Psychology; Humans; Injuries of the limb. Injuries of the spine; Investigative techniques, diagnostic techniques (general aspects); Joints; Male; Medical diagnosis; Medical sciences; Middle Aged; Orthopedics; Physical Examination; Prospective Studies; Reproducibility of Results; Risk factors; Shoulder; Shoulder injuries; Shoulder Joint - injuries; Shoulder Joint - pathology; Shoulder Joint - physiopathology; Sports injuries; Sports medicine; Traumas. Diseases due to physical agents; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546507307508

Background: Glenoid labral tears provide a diagnostic challenge. Hypothesis: Combinations of items in the patient history and physical examination will provide stronger diagnostic accuracy to suggest the presence or absence of glenoid labral tear than will individual items. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: History and examination findings in patients with shoulder pain (N = 55) were compared with arthroscopic findings to determine diagnostic accuracy and intertester reliability. Results: The intertester reliability of the crank, anterior slide, and active compression tests was 0.20 to 0.24. A combined history of popping or catching and positive crank or anterior slide results yielded specificities of 0.91 and 1.00 and positive likelihood ratios of 3.0 and infinity, respectively. A positive anterior slide result combined with either a positive active compression or crank result yielded specificities of 0.91 and positive likelihood ratio of 2.75 and 3.75, respectively. Requiring only a single positive finding in the combination of popping or catching and the anterior slide or crank yielded sensitivities of 0.82 and 0.89 and negative likelihood ratios of 0.31 and 0.33, respectively. Conclusion: The diagnostic accuracy of individual tests in previous studies is quite variable, which may be explained in part by the modest reliability of these tests. The combination of popping or catching with a positive crank or anterior slide result or a positive anterior slide result with a positive active compression or crank test result suggests the presence of a labral tear. The combined absence of popping or catching and a negative anterior slide or crank result suggests the absence of a labral tear. Keywords: labral tear shoulder arthroscopy active compression test crank test anterior slide test