Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain
| aut.relation.startpage | 156 | |
| aut.relation.volume | 14 | |
| aut.researcher | McNair, Peter John | |
| dc.contributor.author | Cadogan, A | |
| dc.contributor.author | McNair, P | |
| dc.contributor.author | Laslett, M | |
| dc.contributor.author | Hing, W | |
| dc.date.accessioned | 2013-05-29T03:21:14Z | |
| dc.date.available | 2013-05-29T03:21:14Z | |
| dc.date.copyright | 2013 | |
| dc.date.issued | 2013 | |
| dc.description.abstract | Background: Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Methods: Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active compression/O’Brien’s test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Results: Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P<0.05) and combinations of traditional tests were not able to discriminate between a PAR and a negative anaesthetic response (AUC 0.507; 95% CI: 0.366, 0.647; P>0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0.41) and four positive clinical features resulted in 95% specificity (95% CI 0.90, 0.98) and a LR+ of 4.98 (95% CI 1.69, 13.84). Conclusions: In this cohort of primary care patients with predominantly subacute or chronic ACJ pain of nontraumatic onset, traditional ACJ tests were of limited diagnostic value. Combinations of other history and physical examination findings were able to more accurately identify injection-confirmed ACJ pain in this cohort. | |
| dc.identifier.citation | BMC Musculoskeletal Disorders 2013, 14:156 | |
| dc.identifier.doi | 10.1186/1471-2474-14-156 | |
| dc.identifier.issn | 1471-2474 | |
| dc.identifier.uri | https://hdl.handle.net/10292/5382 | |
| dc.language | eng | |
| dc.publisher | BioMed Central Ltd | |
| dc.relation.uri | http://dx.doi.org/10.1186/1471-2474-14-156 | |
| dc.rights | Copyright © 2013 The Authors; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The electronic version of this article is the complete one and can be found online at: (see Publisher’s Version). | |
| dc.rights.accessrights | OpenAccess | |
| dc.subject | Sensitivity | |
| dc.subject | Specificity | |
| dc.subject | Shoulder pain | |
| dc.subject | Acromioclavicular joint | |
| dc.subject | Physical examination | |
| dc.subject | Patient history | |
| dc.subject | Local anaesthetic | |
| dc.subject | Primary health care | |
| dc.title | Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain | |
| dc.type | Journal Article | |
| pubs.elements-id | 142755 | |
| pubs.organisational-data | /AUT | |
| pubs.organisational-data | /AUT/Health & Environmental Science |