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Shoulder Physical Exams Found Specific But Not Sensitive

Researchers recommend against relying on tests alone without radiographic evidence

FRIDAY, July 28 (HealthDay News) -- Three common physical examination tests for traumatic anterior shoulder instability -- anterior apprehension, relocation and anterior drawer -- are specific but not sensitive, according to a report published in the July issue of The Journal of Bone & Joint Surgery.

Adam J. Farber, M.D., of Johns Hopkins University in Baltimore, and colleagues studied 363 patients who had a physical exam followed by shoulder arthroscopy.

When the researchers used relief of apprehension as the diagnostic criterion for a positive test, they found that specificity and sensitivity rates were 96 percent and 72 percent, respectively, for the apprehension test, and 92 percent and 81 percent, respectively, for the relocation test. When they used relief of pain as the diagnostic criterion, they found that the specificity and sensitivity rates of both tests were lower. When they used reproduction of instability symptoms as the criterion, they found that the specificity and sensitivity rates were 85 percent and 53 percent, respectively, for the positive anterior drawer test.

"If there is no radiographic evidence of a dislocation, we do not rely on these examinations alone; we recommend diagnostic arthroscopy for any patient with suspected anterior instability of the shoulder," the authors conclude. "The presence of pain with these tests should not be used as a criterion for the diagnosis of traumatic anterior instability."

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