title: The Resisted Supination External Rotation Test Diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: a systematic review of evidence. Biceps Load Test: A Clinical Test for Superior Labrum Anterior and Posterior Lesions in Shoulders With Recurrent Anterior Dislocations The Crank Test, the O'Brien Test, and Routine Magnetic Resonance Imaging Scans in the Diagnosis of Labral Tears * The Active Compression Test: A New and Effective Test for Diagnosing Labral Tears and Acromioclavicular Joint Abnormality An Evaluation of the Apprehension, Relocation, and Surprise Tests for Anterior Shoulder Instability Biceps load test II: A clinical test for SLAP lesions of the shoulder. Clinical assessment of three common tests for traumatic anterior shoulder instability. The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes. Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder. Specificity of the Speed's test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears. Interrater reproducibility of clinical tests for rotator cuff lesions. Diagnostic values of tests for acromioclavicular joint pain. Validity of the supraspinatus test as a single clinical test in diagnosing patients with rotator cuff pathology. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. A modification of the relocation test: arthroscopic findings associated with a positive test. Lag signs in the diagnosis of rotator cuff rupture.
abstract: Purpose To evaluate a new clinical test , the resisted supination external rotation test , for the diagnosis of superior labral anterior posterior lesions of the shoulder . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods Forty athletes ( average age , 23.9 years ) with activity-related shoulder pain were enrolled in the study . The patients underwent 3 different tests design ed specifically to detect superior labral anterior posterior lesions ( the resisted supination external rotation test , the crank test , and the active compression test ) ; the tests were performed in a r and om order on the affected shoulder . The results of the tests were compared with arthroscopic findings . Results Out of 40 athletes , 29 ( 72.5 % ) had superior labral anterior posterior tears . The resisted supination external rotation test had the highest sensitivity ( 82.8 % ) , specificity ( 81.8 % ) , positive predictive value ( 92.3 % ) , negative predictive value ( 64.3 % ) , and diagnostic accuracy ( 82.5 % ) of all tests performed . Conclusion By re-creating the peel-back mechanism , the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests design ed to diagnose superior labral anterior posterior tears in overhead-throwing athletes . By using this test in the context of a thorough clinical history and physical examination , lesions of the superior labrum can be more reliably diagnosed BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies We describe the biceps load test for evaluating the integrity of the superior glenoid labrum in shoulders with recurrent anterior dislocations . With the shoulder in an abducted , externally rotated position and the forearm supinated , active flexion of the elbow against resistance relieves the discomfort of a st and ard apprehension test for anterior shoulder instability . A group of 75 patients with proven unilateral anterior shoulder dislocations were prospect ively examined in a double-blind fashion with arthroscopic examination and the biceps load test . Sixty-three patients had a negative test and 62 of these had an intact biceps tendon-superior labrum complex ; the remaining patient had a type II superior labral anterior and posterior lesion . Twelve patients had positive tests , and 10 had superior labral lesions ; the other 2 patients had intact superior labra . Therefore , the biceps load test revealed a sensitivity of 90.9 % , a specificity of 96.9 % , a positive predictive value of 83 % , a negative predictive value of 98 % , and a kappa coefficient of 0.846 Background Tears of the superior labrum of the shoulder , anterior to posterior , are difficult to diagnose clinical ly . Purpose We examined whether the crank or O'Brien tests were reliable tools for detecting glenoid labral tears . Study Design Nonr and omized prospect i ve study . Methods Results of diagnostic shoulder arthroscopy were compared with those of the preoperative tests and magnetic resonance imaging for 65 patients who had symptoms of shoulder pain . Results The  crank test result was positive in 29 patients ( 45 % ) , and the O'Brien test was positive in 41 patients ( 63 % ) . The crank  test had a positive predictive value of 41 % , was 56 % specific , 46 % sensitive , and had a negative predictive value of 61 % . The  O'Brien test  had a positive predictive value of 34 % , was 31 % specific , 54 % sensitive , and had a negative predictive value of 50 % . Magnetic resonance imaging had a positive predictive value of 63 % , was 92 % specific , 42 % sensitive , and had a negative predictive value of 83 % . Conclusions The O'Brien and crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum . Results were often falsely positive for patients with other shoulder conditions , including impingement or rotator cuff tears Labral tears and acromioclavicular joint abnormalities were differentiated on physical examination using a new diagnostic test . The st and ing patient forward flexed the arm to 90 ° with the elbow in full extension and then adducted the arm 10 ° to 15 ° medial to the sagittal plane of the body and internally rotated it so that the thumb pointed downward . The examiner , st and ing behind the patient , applied a uniform downward force to the arm . With the arm in the same position , the palm was then fully supinated and the maneuver was repeated . The test was considered positive if pain was elicited during the first maneuver , and was reduced or eliminated with the second . Pain localized to the acromioclavicular joint or “ on top ” was diagnostic of acromioclavicular joint abnormality , whereas pain or painful clicking described as “ inside ” the shoulder was considered indicative of labral abnormality . A prospect i ve study was performed on 318 patients to determine the sensitivity , specificity , and positive and negative predictive values of the test . Fifty-three of 56 patients whose preoperative examinations indicated a labral tear had confirmed labral tears that were repaired at surgery . Fifty-five of 62 patients who had pain in the acromioclavicular joint and whose preoperative examinations indicated abnormalilties in the joint had positive clinical , operative , or radiographic evidence of acromioclavicular injury . There were no false-negative results in either group Background Although there are many studies describing tests for shoulder instability , there are few assessing the validity of these tests in diagnosing anterior shoulder instability . Purpose To assess the validity of the apprehension , relocation , and surprise tests as predictors of anterior shoulder instability . Study Design Retrospective review of prospect ively collected data . Methods Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent , blinded examiners : traumatic anterior instability ( 18 ) , rotator cuff tendinosis ( 17 ) , posterior instability ( 2 ) , glenohumeral osteoarthritis ( 4 ) , or multidirectional instability ( 5 ) .  Interobserver reliability was also determined . Results In subjects who had a feeling of apprehension on all three tests , the mean positive and negative predictive values were 93.6 % and 71.9 % , respectively . The surprise test was the single most accurate test ( sensitivity = 63.89 % ; specificity = 98.91 % ) . An improvement in the feeling of apprehension or painwith the relocation test added little to the value of the tests . Interobserver reliability was determined to be 0.83 . Conclusions and Clinical Relevance The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability PURPOSE The purpose of this report is to describe the biceps load test II for evaluating the  superior labral anterior and posterior ( SLAP ) lesions .  TYPE OF STUDY This is a double-blind study in consecutive data , which includes diagnostic accuracy of a test using sensitivity , specificity , and interexaminer reliability . METHODS In the supine position , the arm is elevated to 120 degrees and externally rotated to its maximal point , with the elbow in the 90 degrees flexion and the forearm in the supinated position . The patient is asked to flex the elbow while resisting the elbow flexion by the examiner . The test is considered positive if the patient complains of pain during the resisted elbow flexion . The test is negative if pain is not elicited or if the pre-existing pain during the elevation and external rotation of the arm is unchanged or diminished by the resisted elbow flexion . A prospect i ve study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test II . Two independent examiners were assigned to perform the new diagnostic test . The results of the tests were confirmed during the arthroscopic examination . RESULTS A positive test result in 38 subjects correlated with a SLAP lesion in 35 patients and an intact biceps-superior labrum in 3 patients . A negative test result in 89 patients correlated with an intact superior labrum complex in 85 patients , whereas 4 patients with a negative test result had a type II SLAP lesion . The biceps load test II had a sensitivity of 89.7 % , a specificity of 96.9 % , a positive-predictive value of 92.1 % , a negative-predictive value of 95.5 % , and a kappa coefficient of 0.815 . The abduction and external rotation of the shoulder during the test changes the relative direction of the biceps fiber in a position of oblique angle to the posterosuperior labrum . The resisted contraction of the biceps increases the pain generated on the superior labrum that is already peeled off the glenoid margin in the abducted and externally rotated position . CONCLUSIONS The biceps load test II is an effective diagnostic test for SLAP lesions BACKGROUND Although traumatic anterior shoulder instability is common , the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently . We hypothesized that ( 1 ) such tests would be specific but not sensitive for this condition , ( 2 ) the usefulness of the anterior drawer test would be limited because of pain during the test , and ( 3 ) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms . METHODS Between 2000 and 2004 , 363 patients underwent a physical examination followed by shoulder arthroscopy . Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group , and the remaining patients served as controls . The clinical usefulness of three tests ( anterior apprehension , relocation , and anterior drawer tests ) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity , specificity , and likelihood ratios . RESULTS If demonstration ( or relief ) of apprehension was used as the diagnostic criterion for a positive test , the sensitivity , specificity , and likelihood ratio were 72 % , 96 % , and 20.2 , respectively , for the apprehension test and 81 % , 92 % , and 10.4 , respectively , for the relocation test . If pain ( or relief of pain ) was used as the diagnostic criterion for a positive test , the values for the sensitivity , specificity , and likelihood ratio of both tests were lower . The anterior drawer test could be performed successfully in the physician 's office for 87 % of the patients . If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test , the sensitivity , specificity , and likelihood ratio values of that test were 53 % , 85 % , and 3.6 , respectively . CONCLUSIONS The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive . Apprehension is a better criterion than pain for a positive apprehension or relocation test . The anterior drawer test ( when pain does not prevent it from being performed ) is helpful for diagnosing traumatic anterior instability . LEVEL OF EVIDENCE Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence We conducted this study to determine whether a test , the posterior impingement maneuver , could be used to prospect ively identify articular side tears of the rotator cuff and /or posterior labrum . Sixty-nine athletes presented with posterior shoulder pain that developed during overh and athletics . Injured shoulders were placed into 90 degrees to 110 degrees of abduction , slight extension , and maximum external rotation , and an effort was made to elicit pain deep within the posterior aspect . Overall sensitivity of the test was 75.5 % , and specificity was 85 % . When only athletes with noncontact injuries ( gradual onset of pain ) were considered , sensitivity was 95 % and specificity was 100 % . A positive posterior impingement sign correlated highly with undersurface tearing of the rotator cuff and /or tearing of the posterior labrum in athletes with gradual onset of posterior shoulder pain during overh and athletics PURPOSE Although several clinical tests for detecting superior labral injury of the shoulder have been reported , some of the maneuvers involved are complicated and diagnosis is still inaccurate . The purpose of this report is to introduce our forced shoulder abduction and elbow flexion test ( forced abduction test ) along with an assessment of its efficacy in the throwing shoulder in comparison with other clinical tests . TYPE OF STUDY Prospect i ve nonr and omized clinical trial . METHODS Fifty-four throwing athletes who underwent arthroscopic surgery were prospect ively studied . Superior labral injury was present in 24 cases ( Snyder 's classification was type 2 in 22 , and type 3 in 2 ) . Several clinical tests were performed preoperatively and the results were recorded on our original chart . The condition of the superior labrum was then examined during arthroscopic surgery . The results of these tests were compared with the arthroscopic findings as a st and ard . The forced abduction test was defined as positive when pain at the posterosuperior aspect of the shoulder on forced maximal abduction was relieved or diminished by elbow flexion . RESULTS The sensitivity , specificity , and accuracy of the forced abduction test were 67 % , 67 % , and 67 % , respectively . It was one of the most useful tests , along with the crank test and O'Brien 's test ( crank test , 58 % , 72 % , 66 % ; O'Brien 's test , 54 % , 60 % , 57 % ; respectively ) . Furthermore , the results of the forced abduction test showed a significant correlation with the presence of superior labral injury ( P = .0275 , chi-square test ) . CONCLUSIONS The forced abduction test was technically simple and its usefulness was comparable to the O'Brien 's and crank tests for diagnosing superior labral injury in throwing shoulders . LEVEL OF EVIDENCE Level II A positive Speed 's test result is usually thought to suggest inflammation or lesions related to the biceps/labral complex . The specificity , sensitivity , and positive and negative predictive values are determined for the Speed 's test . A prospect i ve study design was developed for all patients with shoulder pain who presented between October 1 , 1994 and February 28 , 1995 . The clinical results of the Speed 's test were correlated with biceps/labral pathology by direct arthroscopic visualization . A neuroprobe is used to pull the biceps tendon into the articular portion of the glenohumeral joint so as to visualize the biceps tendon at the level of the bicipital groove . Forty-six shoulders in 45 patients , 31 men ( average age , 53 years ; range , 16 to 76 years ) and 14 women ( average age , 64 years ; range , 30 to 80 years ) with 26 dominant and 20 nondominant extremities were operated on during this time interval . The clinical evaluation showed that the  speed 's test  was positive in 40 shoulders .  Biceps/labral complex pathology was present in 10 of these patients . A specificity of 13.8 % , a sensitivity of 90 % , a positive predictive value of 23 % , and a negative predictive value of 83 % were calculated . Thus , it is concluded that the Speed 's test is a nonspecific but sensitive test for macroscopic biceps/labral pathology . This clinical examination is positive with a various number of other pathological shoulder problems PURPOSE The purpose of this study was to explore and describe reasons for variation in diagnostic accuracy of clinical tests using Yergason 's and Speed 's tests in predicting biceps tendon pathology and SLAP lesions . Shoulder arthroscopy was used as the gold st and ard . TYPE OF STUDY Prospect i ve blinded study of consecutive patients with a wide spectrum of shoulder conditions . METHODS One hundred fifty-two subjects ( 65 women and 87 men ) with complaints of shoulder pain were examined . Fifty subjects ( 16 women and 34 men ) ranging in age from 24 to 79 years ( mean age , 50 years ; SD = 14.36 ) met the criteria for surgery . The validity of the Yergason 's and Speed 's tests was evaluated against findings at surgery . RESULTS The surgical findings related to biceps pathology and SLAP lesions were as follows : 2 bicipital tendonitis , both associated with significant rotator cuff pathology ; 10 biceps partial tears ; and 2 complete ruptures . Fifteen patients had SLAP lesion type I , 12 type II , and 1 type IV . The sensitivity , specificity , and positive and negative predictive values were 43 % , 79 % , 60 % , and 65 % for Yergason 's test and 32 % , 75 % , 50 % , and 58 % for Speed 's test , respectively . The likelihood ratios were 1.28 and 0.91 for Speed 's test and 2.05 and 0.72 for Yergason 's test . These ratios were provided to assist clinicians in calculating the probability of biceps pathology and SLAP lesions for a single patient with a different history-specific prevalence of having the pathology . CONCLUSIONS Although Speed 's and Yergason 's tests are moderately specific , they do not generate a large change in the post-test probability and are unlikely to make a significant change in the pretest diagnosis . Clinicians should underst and that clinical examination tests do not perform consistently and have variable predictive values in different patient population s and setting s. LEVEL OF EVIDENCE Level I diagnostic study : testing of previously developed criteria in a series of consecutive patients ( using surgery as gold st and ard ) This study documents the sensitivity and specificity of a clinical test to aid in the diagnosis of superior glenoid labral lesions . The anterior slide test , a method of applying an anteriorly and superiorly directed force to the glenohumeral joint , was performed on several groups of athletes . These included symptomatic athletes with isolated superior labral tears , rotator cuff tears , and instabilities , and asymptomatic athletes with rotational deficits . In addition , non-throwing athletes were tested . The sensitivity of the test was 78.4 % , and the specificity was 91.5 % . This study shows that the anterior slide test can be used in the clinical examination , in that it has high specificity for superior labral lesions , but not enough sensitivity to be the sole diagnostic criterion for these lesions The purpose of this study was to assess the diagnostic accuracy of  transdeltoid palpation ( the rent test ) for the diagnosis of full thickness rotator cuff tear . Clinical and arthroscopic findings were documented prospect ively for 109 consecutive patients undergoing shoulder arthroscopy by the senior author . A retrospective analysis was then performed on these data to assess the accuracy of transdeltoid palpation in the diagnosis of full thickness rotator cuff tear . Transdeltoid palpation was found to have a sensitivity of 95.7 % and specificity of 96.8 % for the diagnosis of full thickness rotator cuff tear . The positive and negative predictive values for  transdeltoid palpation  were 95.7 % and 96.8 % , respectively . Overall , the diagnostic accuracy of  transdeltoid palpation  was 96.3 % . We conclude that transdeltoid palpation is highly accurate for the clinical diagnosis of full thickness rotator cuff tear BACKGROUND Rotator cuff lesions are common in the community but reproducibility of tests for shoulder assessment has not been adequately appraised and there is no uniform approach to their use . OBJECTIVE To study interrater reproducibility of st and ard tests for shoulder evaluation among a rheumatology specialist , rheumatology trainee , and research nurse . METHODS 136 patients were review ed over 12 months at a major teaching hospital . The three assessors examined each patient in r and om order and were unaware of each other 's evaluation . Each shoulder was examined in a st and ard manner by recognised tests for specific lesions and a diagnostic algorithm was used . Between-observer agreement was determined by calculating Cohen 's kappa coefficients ( measuring agreement beyond that expected by chance ) . RESULTS Fair to substantial agreement was obtained for the observations of tenderness , painful arc , and external rotation . Tests for supraspinatus and subscapularis also showed at least fair agreement between observers . 40/55 ( 73 % ) kappa coefficient assessment s were rated at > 0.2 , indicating at least fair concordance between observers ; 21/55 ( 38 % ) were rated at > 0.4 , indicating at least moderate concordance between observers . CONCLUSION The reproducibility of certain tests , employed by observers of varying experience , in the assessment of the rotator cuff and general shoulder disease was determined . This has implication s for delegation of shoulder assessment to nurse specialists , the development of a simplified evaluation schedule for general practitioners , and uniformity in epidemiological research studies BACKGROUND This prospect i ve study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain . METHODS Of 1037 patients with shoulder pain , 113 who mapped pain within an area bounded by the midpart of the clavicle and the deltoid insertion were eligible for inclusion in the study . Forty-two subjects agreed to participate , and four of them were lost to follow-up . Twenty clinical tests , radiography , bone-scanning , magnetic resonance imaging , and an acromioclavicular joint injection test were performed on all patients . The patients were divided into two groups according to whether they had a > or = 50 % decrease in pain following the acromioclavicular joint injection . Statistical analysis , including multivariate regression analysis , was performed in order to evaluate the diagnostic effectiveness of the various tests . RESULTS Acromioclavicular joint pain was confirmed in twenty-eight of the thirty-eight patients . The most sensitive tests were examination for acromioclavicular tenderness ( 96 % sensitivity ) , the Paxinos test ( 79 % ) , magnetic resonance imaging ( 85 % ) , and bone-scanning ( 82 % ) , but these studies had low specificity . In the stepwise regression model , with the response to the injection used as the dependent variable , bone-scanning and the Paxinos test were the only independent variables retained . Patients with a positive Paxinos test as well as a positive bone scan had high post-test odds ( 55:1 ) and a 99 % post-test probability of having pain due to pathological changes in the acromioclavicular joint . The likelihood ratio for patients with one negative test and one positive test was indeterminate ( 0.4:1 ) . Patients with both a negative Paxinos test and a negative bone scan had a likelihood ratio of 0.03:1 for having acromioclavicular joint pain , which basically rules out the disorder . CONCLUSIONS The highly sensitive tests had low specificity , and the highly specific tests had low sensitivity . However , the combination of a positive Paxinos test and a positive bone scan predicted damage to the acromioclavicular joint as the cause of shoulder pain with a high degree of confidence STUDY DESIGN Prospect i ve blinded comparison of clinical examination and surgical findings of consecutive patients seen at a tertiary shoulder center . OBJECTIVE To investigate the validity of the supraspinatus test in diagnosing rotator cuff pathology using arthroscopy or open surgery as reference st and ards . A positive supraspinatus test was defined as pain for all types of rotator cuff pathology and weakness for full-thickness tears . BACKGROUND Rotator cuff tenopathy is a very common condition . However , there have been relatively few studies documenting the validity of physical examination for this condition and further investigation of the measurement properties of these tests is warranted . METHODS AND MEASURES One hundred two consecutive subjects were examined . Fifty subjects , ranging in age between 24 and 79 years ( mean age , 50 years ; SD , 14.4 years ) and composed of 16 females and 34 males , underwent surgery .  RESULTS The sensitivity of the supraspinatus test  was 62 % , 41 % , and 88 % for " supraspinatus tendonitis or partial thickness tear , " " full-thickness tear , " and " large to massive tears , " respectively . The specificity values were 54 % , 70 % , and 70 % for the above conditions , respectively . The negative likelihood ratios varied from 0.17 to 0.84 , and the positive likelihood ratios varied from 1.35 to 2.93 , depending on the presence of pain or weakness . CONCLUSION Application of the supraspinatus test in isolation is helpful in diagnosing large or massive rotator cuff tears . The change that this test makes in pretest probability of less extensive rotator cuff pathology is insignificant You are back where we put you in the previous article1 on diagnostic tests in this series on how to use the medical literature : in the library study ing an article that will guide you in interpreting ventilation-perfusion ( V/Q ) lung scans . Using the criteria in Table 1 , you have decided that the Prospect i ve Investigation of Pulmonary Diagnosis ( PIOPED ) study 2 will provide you with valid information . Just then , another Thirteen overh and -throwing athletes who failed at least 3 months of physical therapy while restricted from throwing and who demonstrated a positive modified relocation test at 90 degrees , 110 degrees , and /or 120 degrees were clinical ly and arthroscopically examined . On arthroscopic examination , all patients demonstrated articular surface pathology .  Eleven patients had fraying of the undersurface of the rotator cuff , and 10 patients had fraying of the posterosuperior labrum . With 90 degrees shoulder abduction , 8 patients had rotator cuff contact with the posterosuperior labrum . When the shoulder was abducted to 110 degrees , all patients demonstrated such contact . At 120 degrees of abduction , 12 patients revealed contact . The presence or absence of pain during the modified relocation test correlated with the presence or absence of cuff contact with the posterosuperior labrum 79 % of the time . Six patients had a positive modified relocation test at all levels of abduction . These patients included 2 with SLAP lesions , 1 with a Bankart lesion , and 1 with a complete tear of the rotator cuff We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospect i ve study of 100 consecutive painful shoulders with impingement syndrome , stages 1 to 3 .  Lag signs were compared with the Jobe and lift-off signs . Three tests were design ed to assess the main components of the rotator cuff : the external rotation lag sign ( ERLS ) for the supraspinatus and the infraspinatus tendons , the drop sign for the infraspinatus , and the internal rotation lag sign ( IRLS ) for the subscapularis tendon . For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the jobe sign . The drop sign was the least sensitive but was as specific as the ERLS . Partial ruptures of the supraspinatus remained concealed to the ERLS . For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign . Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS . The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS . Clinical testing for lag signs was efficient , reproducible , and reliable . In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions
target: No tests for impingement or acromioclavicular ( AC ) joint pathology demonstrated significant diagnostic accuracy .
  Based on pooled data , the diagnostic accuracy of the Neer test for impingement , the Hawkins-Kennedy test for impingement and the Speed test for labral pathology is limited .
  Currently , almost without exception , there is a lack of clarity with regard to whether common OSTs used in clinical examination are useful in differentially diagnosing pathologies of the shoulder
background: OBJECTIVE To compile and critique research on the diagnostic accuracy of individual  orthopaedic physical examination tests in a manner that would allow clinicians to judge whether these tests are valuable to their practice .