Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2022; 13(1): 102-111
Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.102
Comparing shoulder maneuvers to magnetic resonance imaging and arthroscopic findings in patients with supraspinatus tears
Fabio Anauate Nicolao, Joao Alberto Yazigi Junior, Fabio Teruo Matsunaga, Nicola Archetti Netto, Joao Carlos Belloti, Marcel Jun Sugawara Tamaoki
Fabio Anauate Nicolao, Joao Alberto Yazigi Junior, Fabio Teruo Matsunaga, Nicola Archetti Netto, Joao Carlos Belloti, Marcel Jun Sugawara Tamaoki, Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
Fabio Anauate Nicolao, Joao Alberto Yazigi Junior, Orthopedics and Traumatology Discipline, Universidade de Santo Amaro – UNISA, Sao Paulo 04829-300, Brazil
Author contributions: Anauate Nicolao F assisted with data analysis; Anauate Nicolao F, Yazigi Junior JA, Archetti Netto N, and Tamaoki MJS were involved in data collection; Yazigi Junior JA drafted the manuscript; Anauate Nicolao F, Matsunaga FT, Belloti JC participated in the design of the study; Tamaoki MJS, masterminded the study and performed the final review.
Institutional review board statement: The study was approved by institutional review board of the Universidade Federal de São Paulo – UNIFESP under registration number 1662/2016.
Clinical trial registration statement: This study is registered at https://doi.org/10.1186/ISRCTN13083925. The registration identification number is ISRCTN13083925.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare any conflicting interests related to this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at junioryazigi73@yahoo.com.br.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joao Alberto Yazigi Junior, PhD, Doctor, Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, 778 Borges Lagoa Road, Sao Paulo 04038-001, Brazil. junioryazigi73@yahoo.com.br
Received: March 11, 2021
Peer-review started: March 11, 2021
First decision: July 28, 2021
Revised: August 9, 2021
Accepted: December 21, 2021
Article in press: December 21, 2021
Published online: January 18, 2022
Abstract
BACKGROUND

Shoulder maneuvers and magnetic resonance imaging (MRI) are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam. Although there are many studies on this subject, there is a lack of studies comparing the sensitivity (Se) and specificity (Sp) of shoulder maneuvers and MRI to arthroscopic findings (intact, partial, or full thickness supraspinatus tendon tear).

AIM

To compare the diagnostic values of shoulder maneuvers with MRI for supraspinatus tendon tears in patients undergoing shoulder arthroscopy.

METHODS

A total of 199 consecutive patients from four orthopedic centers met the eligibility criteria of shoulder pain persisting for at least four weeks. They were prospectively enrolled in this study from April 2017 to April 2019. Seven clinical tests (full can, empty can, drop arm, Hawkins’, painful arc, Neer’s sign and resisted external rotation) and MRI were performed, and all were compared with surgical findings. Full can, empty can and resisted external rotation tests were interpreted as positive in the case of pain and/or weakness. We assessed the Se, Sp, accuracy, positive predictive value (PPV) and negative predictive value (NPV), positive and negative likelihood ratio and diagnostic odds ratio for overall, partial and full-thickness supraspinatus tears.

RESULTS

MRI had the highest Se for overall (0.97), partial (0.91) and full-thickness (0.99) tears; moreover, MRI had the highest NPV: 0.90, 0.88 and 0.98 for overall, partial and full-thickness tears, respectively. For overall supraspinatus tears, the Se and PPV were: Painful arc (Se = 0.85/PPV = 0.91), empty can (pain) (Se = 0.80/PPV = 0.89), full can (pain) (Se = 0.78/PPV = 0.90), resisted external rotation (pain) (Se = 0.48/PPV = 0.87), drop arm (Se = 0.19/PPV = 0.97), Neer’s sign (Se = 0.78/PPV = 0.93) and Hawkins’ (Se = 0.80/PPV = 0.88). MRI had the highest PPV (0.99). The Hawkin’s test had the highest false positive rate in patients with intact tendons (0.36). The Sp of the empty can and full can (both tests positive for pain and weakness), drop arm and MRI were: 0.93, 0.91, 0.98 and 0.96, respectively. For partial and full-thickness tears, the empty can test (positive for pain and weakness) had a Sp of 0.93, and the drop arm and MRI had the same Sp (0.98).

CONCLUSION

Physical examination demonstrated good diagnostic value, the drop arm test had a Sp as good as MRI for supraspinatus tears; however, MRI was more accurate in ruling out tears. The Hawkins’ test had high false-positive findings in patients with intact tendons.

Keywords: Rotator cuff injuries, Physical examination, Magnetic resonance imaging, Arthroscopy

Core Tip: Shoulder maneuvers and magnetic resonance imaging (MRI) are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam. The shoulder maneuvers are useful for diagnosing supraspinatus tears in patients for whom surgery is being considered; however, they showed limited values in ruling out tears compared with MRI. Moreover, some shoulder maneuvers had high false-positive findings in patients with intact tendons.