SLAP tears and return to sport and work: current concepts.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Competing interests: AAR provides research support for Arthrex, Inc. and Northwell Health. AAR is a paid consultant for Arthrex, Inc. and Paragen Technologies. AAR receives royalties from Saunders/Mosby-Elsevier. N.N.V. and Arthrex, Inc. AAR is a stockholder in Healthpoint Capital, DuPage Medical Group and Paragen Technologies. AAR provides publisher support for Slack, Inc., Orthopedics Today and Saunders/Mosby-Elsevier. N.N.V. and is on the editorial boards of Techniques in Shoulder and Elbow, Techniques in Sports Medicine, Sports Health and Orthopedics and is the chief medical editor of Orthopedics Today. EC is a paid presenter or speaker for DePuy, Smith & Nephew and Stryker as well as a paid consultant for Johnson & Johnson and research support for Smith & Nephew. EC is a board or committee member for the European Society for Surgery of the Shoulder and Elbow as well as the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine. EC is also a member of the editorial or governing board of the Journal of Shoulder and Elbow Surgery. ADM is a research support and consultant for Arthrex, Inc. 2. Br J Sports Med. 2008 Feb;42(2):80-92; discussion 92. doi: 10.1136/bjsm.2007.038406. Epub 2007 Aug 24. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Hegedus EJ(1), Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd, Cook C. Author information: (1)Duke University, DUMC 3907, Durham, NC 27710, USA. eric.hegedus@duke.edu Comment in J Athl Train. 2010 Jul-Aug;45(4):404-6. doi: 10.4085/1062-6050-45.4.404. 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. METHODS: A computer-assisted literature search of MEDLINE, CINAHL, and SPORTDiscus databases (1966 to October 2006) using keywords related to diagnostic accuracy of physical examination tests of the shoulder. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to critique the quality of each paper. Meta-analysis through meta-regression of the diagnostic odds ratio (DOR) was performed on the Neer test for impingement, the Hawkins-Kennedy test for impingement, and the Speed test for superior labral pathology. RESULTS: Forty-five studies were critiqued with only half demonstrating acceptable high quality and only two having adequate sample size. For impingement, the meta-analysis revealed that the pooled sensitivity and specificity for the Neer test was 79% and 53%, respectively, and for the Hawkins-Kennedy test was 79% and 59%, respectively. For superior labral (SLAP) tears, the summary sensitivity and specificity of the Speed test was 32% and 61%, respectively. Regarding orthopaedic special tests (OSTs) where meta-analysis was not possible either due to lack of sufficient studies or heterogeneity between studies, the list that demonstrates both high sensitivity and high specificity is short: hornblowers's sign and the external rotation lag sign for tears of the rotator cuff, biceps load II for superior labral anterior to posterior (SLAP) lesions, and apprehension, relocation and anterior release for anterior instability. Even these tests have been under-studied or are from lower quality studies or both. No tests for impingement or acromioclavicular (AC) joint pathology demonstrated significant diagnostic accuracy. CONCLUSION: 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. There is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the numerous physical examination tests of the shoulder. 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. DOI: 10.1136/bjsm.2007.038406