The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study.
Nitin B Jain, Jennifer Luz, Laurence D Higgins and 4 others
PMID 27386812WHAT IT FOUND
Jobe's test was positive in 88% of patients with rotator cuff tears.
The drop arm test was positive in 24%, but a positive result made a tear likely. Negative results did not rule out a tear.
Key findings
01Jobe's test had a sensitivity of 88% and a specificity of 62% for rotator cuff tear.
02The drop arm test had a specificity of 96% and a sensitivity of 24% for rotator cuff tear.
03The external rotation lag sign at 0° had a specificity of 98% for detecting infraspinatus tears.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The paper states 208 participants were recruited and that 12 patients with missing special test data and 9 patients without MRI were excluded from the analysis, but it does not state the final analysed number. The patients were recruited from sports medicine and shoulder clinics at academic medical centers, so the number with rotator cuff tears may be higher than in primary care. The examiners were not blinded to the patient's history, and the special tests were not always performed in the same order. The study did not check inter-rater or intra-rater reliability among the clinicians performing the tests in this cohort. Some test results were inconclusive because patients were in too much pain, and those results were not included in the accuracy calculations. The MRI was read at least 2 months after the clinical encounter, not at the time of the examination. There were fewer patients with subscapularis tears, so the results for tests aimed at those tears are less secure.
The easy way to misread this
Do not use a negative drop arm test to rule out a supraspinatus tear. It was positive in 24% of patients with a tear, and a negative test does not provide conclusive information.