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Welch M, Rankin S, How Saw Keng M, Woods D. A systematic review of the treatment of primary acromioclavicular joint osteoarthritis. Shoulder Elbow 2024; 16:129-144. [PMID: 38655415 PMCID: PMC11034467 DOI: 10.1177/17585732231157090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 04/26/2024]
Abstract
Background This systematic review aims to comprehensively summarise and present the available evidence for the treatment of primary acromioclavicular joint (ACJ) osteoarthritis (OA). Methods Five databases were searched for studies investigating the management of ACJ OA. Included were studies with participants with clinical/radiological signs of primary ACJ OA, an intervention and included a functional outcome measure. Results Forty-eight studies were included. Treatments consisted of physiotherapy (n = 1 study), medical only (n = 11) and operative management (n = 36). Operative studies included five comparative trials - physiotherapy versus surgery (n = 1) and open versus arthroscopic resection (n = 4). A total of 1902 shoulders were treated for ACJ OA, mean age (51 years), 58% male and mean follow-up (28.5 months). Treatment with injection showed a mean improvement of 50% in pain levels at follow-up (mean = 7.5 months). The commonest surgical procedure was arthroscopic excision of the distal clavicle and operative studies averaged 6 months of conservative management and a mean functional outcome of 87.8%. Conclusion Studies varied in indication, intervention and quality but it did not provide evidence that both non-operative and operative interventions are effective. There was no significant difference between open or arthroscopic distal clavicle excision (DCE). Participants having between 0.5 and 2 cm of clavicle excised had good outcomes and those requiring concomitant shoulder procedures had similarly good outcomes.
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Affiliation(s)
- Matthew Welch
- Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Sally Rankin
- Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Matthew How Saw Keng
- Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - David Woods
- Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
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2
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Kajita Y, Takahashi R, Sagami R, Harada Y, Iwahori Y. Bone marrow edema in the acromioclavicular joint after arthroscopic rotator cuff repair. J Orthop Sci 2023:S0949-2658(23)00333-0. [PMID: 38142156 DOI: 10.1016/j.jos.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Bone marrow edema (BME) in the acromioclavicular joint (ACj) may occur after arthroscopic rotator cuff repair (ARCR), resulting in persistent postoperative ACj pain. We investigated the incidence and clinical characteristics of BME in ACj after ARCR. METHODS Patients exhibiting ACj-related symptoms prior to ARCR surgery, no BME in the ACj on MRI, and an ability to undergo 2-year postoperative physical and MRI examinations of the ACj were included. Patients who underwent distal clavicle resection or osteophyte resection below the ACj and those unable to achieve primary repair of the rotator cuff were excluded. MRI evaluation was performed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients who showed BME in ACj on fat-suppressed T2 MRI at 24 months postoperatively were classified into the BME + group, and those with no BME were classified into the BME- group. Patient background, operation time, Japanese Orthopedic Association (JOA) score, re-tear rate, ACj tenderness, and cross-body adduction test were compared between groups. In addition, we examined the time of occurrence of BME. RESULTS A total of 345 ARCRs were performed during the study period. After the exclusion of 114 shoulders, the remaining 231 shoulders were included in this study. There were 208 cases in the BME- group and 23 cases in the BME + group. The incidence of BME was 9.96 %. Although the JOA scores of both groups showed a significant improvement postoperatively compared to preoperatively, there was no significant difference between the two groups. In terms of re-tear, there was 1 case in the BME + group and 7 in the BME- group. Positive ACj tenderness and cross-body adduction test were significantly higher in the BME + group (P < 0.001). BME occurred in 6 cases at 3 months, 9 cases at 6 months, and 8 cases at 1 year postoperatively. None of the patients developed BME at more than 1 year postoperatively. BME was observed on MRI in all cases at 2 years postoperatively. CONCLUSIONS The rate of occurrence of BME in the ACj after ARCR was 9.96 %. Patients with BME were significantly more likely to have ACj tenderness and positive cross-body adduction test. BME in the ACj often occurs within 6 months to 1 year after ARCR of small-to-medium rotator cuff tears, suggesting a relationship with postoperative functional improvement of the shoulder joint. The ACj should be considered as a potential site of persistent pain after ARCR for small-to-medium rotator cuff tears.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | | | - Ryosuke Sagami
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
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3
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Yazigi Junior JA, Anauate Nicolao F, Matsunaga FT, Archetti Netto N, Belloti JC, Sugawara Tamaoki MJ. Supraspinatus tears: predictability of magnetic resonance imaging findings based on clinical examination. J Shoulder Elbow Surg 2021; 30:1834-1843. [PMID: 33675978 DOI: 10.1016/j.jse.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The shoulder physical examination is frequently performed to diagnose rotator cuff tears in clinical practice; however, there is insufficient evidence on which physical tests are efficient for shoulder impingements in primary care settings. The purposes of this study were (1) to analyze the accuracy of 8 clinical tests to diagnose supraspinatus tendon lesions and investigate whether the combination of these tests can improve the diagnostic values; (2) to assess which are the best positivity criteria for shoulder maneuvers-pain and/or weakness; and (3) to investigate the ability of these tests to distinguish between partial- and full-thickness tears. METHODS A total of 733 consecutive patients were prospectively evaluated by 4 shoulder surgeons in this multicenter diagnostic study from May 2017 to December 2018, and 8 clinical tests (empty-can, full-can test, drop arm, painful arc, Neer sign, Hawkins test, Patte test, and resisted external rotation) were compared with magnetic resonance imaging performed by blinded radiologists. We assessed the sensitivity, specificity, accuracy, positive and negative predictive values, and diagnostic odds ratio (DOR) for all tests. RESULTS For overall supraspinatus tears, the empty-can test showed the highest sensitivity (0.81), the Patte test (positive for pain and weakness) and the drop-arm test showed the highest specificity (0.99 and 0.98, respectively), and the best combination was the Neer sign and the drop-arm test (DOR, 12.92). The positivity criteria for pain associated with weakness showed the highest performance, with DORs of 16.94 for the Patte test and 10.45 for the empty-can test. The Patte test and resisted external rotation, positive for pain and weakness, showed the highest ability to distinguish between full- and partial-thickness tears (DOR, 5.69 and 5.35, respectively). The shoulder maneuvers showed low negative predictive values; the highest value (0.58) was found with the empty-can test. CONCLUSIONS (1) The clinical tests demonstrated excellent diagnostic values; the empty-can test had the highest sensitivity, whereas the drop-arm test and the Patte test had the highest specificity; and the best combination for detecting supraspinatus tears was the Neer sign and the drop-arm test. On the other hand, the physical examination findings showed limited values to rule out tears. (2) The best positivity criterion for shoulder maneuvers was pain associated with weakness. (3) The Patte test and resisted external rotation showed the highest ability to distinguish between full- and partial-thickness tears.
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Affiliation(s)
- João Alberto Yazigi Junior
- Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Orthopedics and Traumatology Department, Universidade de Santo Amaro (UNISA), Santo Amaro, Brazil.
| | - Fábio Anauate Nicolao
- Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Orthopedics and Traumatology Department, Universidade de Santo Amaro (UNISA), Santo Amaro, Brazil
| | - Fábio Teruo Matsunaga
- Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Nicola Archetti Netto
- Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - João Carlos Belloti
- Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcel Jun Sugawara Tamaoki
- Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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4
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Compagnoni R, Stoppani C, Menon A, Cosmelli N, Fossati C, Ranuccio F, Randelli P. Management of Acromioclavicular Osteoarthritis in Rotator Cuff Tears: A Scoping Review. JOINTS 2021; 7:199-204. [PMID: 34235385 PMCID: PMC8253604 DOI: 10.1055/s-0041-1730378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 04/18/2021] [Indexed: 11/21/2022]
Abstract
Purpose
The treatment of acromioclavicular joint (ACJ) osteoarthritis during shoulder arthroscopy is a discussed topic. The aim of this scoping review is to report the current recommendations regarding the management of this disorder in patients undergoing surgery for rotator cuff tears.
Methods
A scoping review was performed in Pubmed\Medline and Embase in March 2017, restricted to English language literature. The following keywords were used: (“rotator cuff tear” OR ” rotator cuff” OR “rotator cuff repair”) AND (“acromioclavicular joint arthritis” OR “ac joint arthritis” OR “ac joint” OR “acromioclavicular joint”). Inclusion criteria were randomized controlled trials, prospective cohort studies, retrospective trials, and therapeutic case series. Exclusion criteria were reviews, meta-analyses, and expert opinions.
Results
Two retrospective studies and three randomized controlled trials were identified. Clinical studies reported results of 443 shoulders, with an average age of 60.48 years and a mean follow-up of 31.7 months. Many differences were found regarding the design of the studies, patient's selection, surgical procedures, and instrumental and clinical evaluations. No statistically significant differences were found in clinical outcome scores between patients that underwent rotator cuff repair in association with distal clavicular resection and patients with isolated rotator cuff repair.
Conclusion
Results of this scoping review underline a lack of evidence-based recommendations about the management of ACJ osteoarthritis in association with arthroscopic rotator cuff repair. Surgical procedures such as distal clavicle resection (DCR) should be performed carefully in this cohort of patients. More prospective randomized studies are needed to reach a consensus about the correct surgical approach to DCR in patients with signs of ACJ osteoarthritis and rotator cuff tears.
Level of Evidence
Level III.
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Affiliation(s)
- Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Carlo Stoppani
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Nicolò Cosmelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | | | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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5
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Sconfienza LM, Adriaensen M, Albano D, Allen G, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Olchowy C, Orlandi D, Plagou A, Prada Gonzalez R, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Obradov M. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part I, shoulder. Eur Radiol 2019; 30:903-913. [PMID: 31529252 DOI: 10.1007/s00330-019-06419-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/07/2019] [Accepted: 08/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Image-guided interventional procedures around the shoulder are commonly performed in clinical practice, although evidence regarding their effectiveness is scarce. We report the results of a Delphi method review of evidence on literature published on image-guided interventional procedures around the shoulder with a list of clinical indications. METHODS Forty-five experts in image-guided musculoskeletal procedures from the ESSR participated in a consensus study using the Delphic method. Peer-reviewed papers regarding interventional procedures around the shoulder up to September 2018 were scored according to the Oxford Centre for Evidence-based Medicine levels of evidence. Statements on clinical indications were constructed. Consensus was considered as strong if more than 95% of experts agreed and as broad if more than 80% agreed. RESULTS A total of 20 statements were drafted, and 5 reached the highest level of evidence. There were 10 statements about tendon procedures, 6 about intra-articular procedures, and 4 about intrabursal injections. Strong consensus was obtained in 16 of them (80%), while 4 received broad consensus (20%). CONCLUSIONS Literature evidence on image-guided interventional procedures around the shoulder is limited. A strong consensus has been reached for 80% of statements. The ESSR recommends further research to potentially influence treatment options, patient outcomes, and social impact. KEY POINTS • Expert consensus produced a list of 20 evidence-based statements on clinical indications of image-guided interventional procedures around the shoulder. • The highest level of evidence was reached for five statements. • Strong consensus was obtained for 16 statements (80%), while 4 received broad consensus (20%).
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, the Netherlands
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy
| | - Georgina Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK.,University of Oxford, Oxford, UK
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Ian Beggs
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Bianca Bignotti
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy
| | - Angelo Corazza
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy.,Department of Neurosciences, University of Genova, Genoa, Italy
| | - Danoob Dalili
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Nuffield Orthopaedic Hospital, Oxford, UK
| | - Miriam De Dea
- UOC Radiologia, Ospedale di Feltre, AULSS 1 Dolomiti, Veneto, Italy
| | - Jose Luis Del Cura
- Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain.,University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy
| | - Eleni Drakonaki
- Department of Musculoskeletal Radiology, Private Ultrasound Institution, Heraklion, Greece
| | - Fernando Facal de Castro
- IBERORAD 1895 S.L., 08021, Barcelona, Spain.,Department of Radiology, General University Hospital of Valencia, Valencia, Spain
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gielen
- University of Antwerp, University of Antwerp Hospital (UZA), Antwerp, Belgium
| | | | | | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Silvia Martin
- Hospital Son Llatzer, Palma de Mallorca, Spain.,Universidad de las Islas Baleares, Palma, Spain
| | - Carlo Martinoli
- DISSAL Department of Health Sciences, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Catherine McCarthy
- Nuffield Orthopaedic Hospital, Oxford, UK.,Oxford Musculoskeletal Radiology, Oxford, UK
| | | | - Kalliopi Melaki
- Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Rebeca Mirón Mombiela
- Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain.,Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | | | - Cyprian Olchowy
- Department of Oral Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
| | | | - Saulius Rutkauskas
- Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
| | - Ziga Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
| | - Alberto Stefano Tagliafico
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.,Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | | | - Violeta Vasilevska-Nikodinovska
- Medical Faculty, University "Ss.Cyril and Methodius", Skopje, North Macedonia; University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia
| | - Jelena Vucetic
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain.,Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | - David Wilson
- St Luke's Radiology Oxford Ltd, Oxford, UK.,University of Oxford, Oxford, UK
| | - Federico Zaottini
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,Varelli Institute, Naples, Italy
| | - Marina Obradov
- Sint Maartenskliniek, 6500GM, 9011, Nijmegen, the Netherlands
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6
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Riley SP, Tafuto V, Cote M, Brismée JM, Wright A, Cook C. Preliminary reliability and validity of the shoulder functional reach score. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1733. [PMID: 30035350 DOI: 10.1002/pri.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/16/2018] [Accepted: 06/15/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to determine (a) if the newly developed shoulder functional reach score (SFRS) is reliable; (b) if the SFRS demonstrates construct validity by being able to differentiate between patients' symptomatic and asymptomatic shoulders; (c) if the SFRS is able to detect changes over time; and (d) if the potential changes in the SFRS demonstrated criterion validity at three different time intervals by being associated the Numeric Pain Rating Scale (NPRS) and Shoulder Pain and Disability Index (SPADI). METHODS Patients were consecutively screened for consultation related to complaints of shoulder pain. Thirty-eight subjects agreed to participate and signed informed consent. Twenty-nine subjects fulfilled the study after the 4 weeks of follow-up. Outcome measures were collected at the initial evaluation and at the first follow-up visit prior to the initiation of treatment. Data were then collected after 2 and 4 weeks of treatment. RESULTS There were statistically significant differences between symptomatic and asymptomatic shoulders on the SFRS. Intratester reliability of the SFRS was intraclass correlation coefficient (ICC2,1 ) = 0.94. Intertester reliability of the SFRS was ICC2,1 = 0.92. Statistically significant differences were observed between the initial evaluation, 2 and 4 weeks for the SFRS, SPADI, and NPRS. Moderate (rs = 0.62) to strong (rs = 0.87) positive correlations were observed between the NPRS and SPADI. Moderate negative (rs = -0.50-0.51) correlations were found between the SFRS and the SPADI. Moderate negative (rs = -0.36-0.54) statistically significant (p < 0.05) correlations were found between the SFRS and the NPRS. CONCLUSION In this small sample, the SFRS was an objective, reliable, and valid tool for assessing shoulder active range of motion in a clinical setting.
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Affiliation(s)
- Sean P Riley
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield Connecticut
| | - Vincent Tafuto
- Department of Rehabilitation, UConn Health, Farmington, Connecticut
| | - Mark Cote
- Department of Orthopaedics, UConn Health, Farmington, Connecticut
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Alexis Wright
- Department of Physical Therapy, High Point University, High Point, North Carolina
| | - Chad Cook
- Doctor of Physical Therapy (DPT) Division, Duke University, Durham, North Carolina
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7
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Trevethan R. Sensitivity, specificity, and allowing the data to speak. Vascular 2018; 26:62. [DOI: 10.1177/1708538117721623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert Trevethan
- Independent Academic Researcher and Author, Albury, New South Wales, Australia
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8
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Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. PHYSICIAN SPORTSMED 2018; 46:98-104. [PMID: 29210329 PMCID: PMC6396285 DOI: 10.1080/00913847.2018.1413920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology. METHODS A systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities. RESULTS The optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O'Brien's Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O'Brien's Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35). CONCLUSION No combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O'Brien's Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint corticosteroid injection may be an appropriate new standard for treatment and surgical decision-making. LEVEL OF EVIDENCE II - Systematic Review.
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Affiliation(s)
- Michael K Krill
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
- b Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Samuel Rosas
- c Baptist Health, Department of Orthopedic Surgery , Wake Forest University , Winston-Salem , NC , USA
| | - KiHyun Kwon
- d Florida International University Herbert Wertheim College of Medicine , Miami , FL , USA
| | - Andrew Dakkak
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
| | - Benedict U Nwachukwu
- e Department of Orthopedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Frank McCormick
- f Department of Orthopedics , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
- g Department of Sports Medicine , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
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Trevethan R. Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Front Public Health 2017; 5:307. [PMID: 29209603 PMCID: PMC5701930 DOI: 10.3389/fpubh.2017.00307] [Citation(s) in RCA: 761] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/03/2017] [Indexed: 01/05/2023] Open
Abstract
Within the context of screening tests, it is important to avoid misconceptions about sensitivity, specificity, and predictive values. In this article, therefore, foundations are first established concerning these metrics along with the first of several aspects of pliability that should be recognized in relation to those metrics. Clarification is then provided about the definitions of sensitivity, specificity, and predictive values and why researchers and clinicians can misunderstand and misrepresent them. Arguments are made that sensitivity and specificity should usually be applied only in the context of describing a screening test’s attributes relative to a reference standard; that predictive values are more appropriate and informative in actual screening contexts, but that sensitivity and specificity can be used for screening decisions about individual people if they are extremely high; that predictive values need not always be high and might be used to advantage by adjusting the sensitivity and specificity of screening tests; that, in screening contexts, researchers should provide information about all four metrics and how they were derived; and that, where necessary, consumers of health research should have the skills to interpret those metrics effectively for maximum benefit to clients and the healthcare system.
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Affiliation(s)
- Robert Trevethan
- Independent academic researcher and author, Albury, NSW, Australia
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Kim SJ, Lee HS. Lidocaine Test Increases the Success Rates of Corticosteroid Injection in Impingement Syndrome. PAIN MEDICINE 2016; 17:1814-1820. [DOI: 10.1093/pm/pnw018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Eikelenboom N, Smeele I, Faber M, Jacobs A, Verhulst F, Lacroix J, Wensing M, van Lieshout J. Validation of Self-Management Screening (SeMaS), a tool to facilitate personalised counselling and support of patients with chronic diseases. BMC FAMILY PRACTICE 2015; 16:165. [PMID: 26560970 PMCID: PMC4641335 DOI: 10.1186/s12875-015-0381-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/28/2015] [Indexed: 01/08/2023]
Abstract
Background A rising number of people with chronic conditions is offered interventions to enhance self-management. The responsiveness of individuals to these interventions depends on patient characteristics. We aimed to develop and validate a tool to facilitate personalised counselling and support for self-management in patients with chronic diseases in primary care. Methods We drafted a prototype of the tool for Self-Management Screening (SeMaS), comprising 27 questions that were mainly derived from validated questionnaires. To reach high content validity, we performed a literature review and held focus groups with patients and healthcare professionals as input for the tool. The characteristics self-efficacy, locus of control, depression, anxiety, coping, social support, and perceived burden of disease were incorporated into the tool. Three items were added to guide the type of support or intervention, being computer skills, functioning in groups, and willingness to perform self-monitoring. Subsequently, the construct and criterion validity of the tool were investigated in a sample of 204 chronic patients from two primary care practices. Patients filled in the SeMaS and a set of validated questionnaires for evaluation of SeMaS. The Patient Activation Measure (PAM-13), a generic instrument to measure patient health activation, was used to test the convergent construct validity. Results Patients had a mean age of 66.8 years and 46.6 % was female. 5.9 % did not experience any barrier to self-management, 28.9 % experienced one minor or major barrier, and 30.4 % two minor or major barriers. Compared to the criterion measures, the positive predictive value of the SeMaS characteristics ranged from 41.5 to 77.8 % and the negative predictive value ranged from 53.3 to 99.4 %. Crohnbach’s alpha for internal consistency ranged from 0.56 to 0.87, except for locus of control (α = 0.02). The regression model with PAM-13 as a dependent variable showed that the SeMaS explained 31.7 % (r2 = 0.317) of the variance in the PAM-13 score. Conclusions SeMaS is a short validated tool that can signal potential barriers for self-management that need to be addressed in the dialogue with the patient. As such it can be used to facilitate personalised counselling and support to enhance self-management in patients with chronic conditions in primary care. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0381-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie Eikelenboom
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 114, 6500, HB, Nijmegen, The Netherlands. .,DOH care group, P.O. Box 704, , 5600, AS, Eindhoven, The Netherlands.
| | - Ivo Smeele
- DOH care group, P.O. Box 704, , 5600, AS, Eindhoven, The Netherlands.
| | - Marjan Faber
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 114, 6500, HB, Nijmegen, The Netherlands.
| | - Annelies Jacobs
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 114, 6500, HB, Nijmegen, The Netherlands.
| | - Frank Verhulst
- Doen en blijven doen, Icaruslaan 39, 5631 LH, Eindhoven, The Netherlands.
| | - Joyca Lacroix
- Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands.
| | - Michel Wensing
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 114, 6500, HB, Nijmegen, The Netherlands.
| | - Jan van Lieshout
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 114, 6500, HB, Nijmegen, The Netherlands.
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Draghi F, Scudeller L, Draghi AG, Bortolotto C. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound 2015; 18:151-8. [PMID: 26191110 DOI: 10.1007/s40477-015-0167-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population. METHODS A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed. RESULTS A total of 1147 shoulder video clips were re-evaluated, and 1587 pathologies were detected; 65.5 % of patients had only one pathology, 30.4 % had two and 4.1 % presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value <0.01. CONCLUSIONS Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors.
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Affiliation(s)
- Ferdinando Draghi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
| | - Luigia Scudeller
- Biostatistics and Clinical Epidemiology Unit, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
| | - Anna Guja Draghi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
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