Hegedus shoulder examination meta-analysis

Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests.

Hegedus EJ, Goode AP, Cook CE, et al. British journal of sports medicine 2012 · PMID 22773322 · doi:10.1136/bjsports-2012-091066

Question

How accurate are individual physical examination tests for diagnosing shoulder pathology?

Design

Systematic review and meta-analysis of diagnostic accuracy studies.

Patients

Patients with shoulder complaints assessed with clinical tests against a reference standard.

Intervention

Individual special tests (e.g. impingement, rotator cuff, labral tests)

Comparison

Reference standard (surgery, imaging)

Primary outcome

Sensitivity, specificity and likelihood ratios

Key result

Most individual shoulder tests had limited diagnostic accuracy on their own, and many labral and impingement tests performed poorly.

Limitations

Included studies were heterogeneous and often at high risk of bias.

Impact on practice

Encourages clusters of tests combined with history and targeted imaging rather than reliance on any single special test.