Title: A sono-clinical study: Is probe palpation better than a cross arm test for detecting acromio-clavicular joint pathology in chronic painful shoulder?
Authors: Dr Sourav Iswarari, Dr Nahid Reza, Dr Kshetra Madhab Das
DOI: https://dx.doi.org/10.18535/jmscr/v6i5.50
Abstract
Objective: This prospective study was undertaken to determine whether palpation is more informative then cross arm test in diagnosing chronic acromio-clavicular joint pain (ACJ). This study used high resolution ultrasonography (HRU) as gold standard to confirm the findings of clinical examinations in patients presenting with chronic painful shoulder of multiple etiology.
Methods: It is a non-interventional prospective observational study. The physicians performing the clinical shoulder examinations and those performing sono imaging were blinded to the results each made.
Results: There were 73 patients, 35 males and 38 females whose mean age was 47.6 ± 11.51 years (range 22-80 years). Of them 36 patient had AC joint affection. Cross-arm test (CAT) showed sensitivity of 86.1 %, specificity of 91.9 %, positive predictive values of 91.9%,negative predictive value 87.2 %, positive likelihood ratio 10.63, negative likelihood ratio 0.15, Cohen’s κ coefficient 0.781. Probe palpation tenderness showed sensitivity of 100 %, specificity of 67.6 %, positive predictive values 75 %, negative predictive value 100 %, positive likelihood ratio 3.09, negative likelihood ratio 0, Cohen’s κ coefficient 0.673. Both the CAT and Probe tenderness showed strong correlation with a Pearson coefficient of 0.782 and 0.712.
Conclusion: Cross arm Test is the most rational singular choice of test to be performed with confidence and it has better validity than probe palpation in diagnosing chronic painfully restricted shoulder with acromio-clavicular joint pathology.
Keywords: Cross-Arm Test, Palpation, Acromio-clavicular joint pathology.
References
- Samira Saraya Rehab El Bakry Ultrasound: Can it replace MRI in the evaluation of the rotator cuff tears? The Egyptian Journal of Radiology and Nuclear Medicine (2016) 47, 193–201.
- Naredo E,Michael W O"Dale,C David Lin,J.Ricky Sing ,George C. Christolias (2016) 'The Physiatric History And Physical Examination ', in David X. Cifu (ed.)Braddom"s Physical Medicine & Rehabilitation. Philadelphia: Elsevier, pp. 20.
- Efstathios Chronopoulos, Tae Kyun Kim,Hyung Bin Park,Diane Ashenbrenner, Edward G. McFarland (2004) 'Diagnostic Value of Physical Tests for Isolated Chronic Acromioclavicular Lesions',Am J of Sports Med, Vol 32(Issue 3), pp. 655-661.
- Raphael Micheroli Correlation of findings in clinical and high resolution ultrasono-graphy examinations of the painful shoulder Journal of Ultrasonography 2015; 15: 29–44.
- Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen, Denmark Andrew Grainger, UK Franz Kainberger, Austria Andrea Klauser, Austria Carlo Martinoli, Italy Eugene McNally, UK Philip J. O’Connor, UK Philippe Peetrons, Belgium Monique Reijnierse, The Netherlands Philipp Remplik, Germany Enzo Silvestri, Italy (2016) Musculoskeletal Ultrasound Tech-nical Guidelines I. Shoulder, Available at: https://essr.org/content-essr/ uploads// 10/shoulder.pdf (Accessed: 2016).
- Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA et al.: Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60: 641–649.
- Stefano Bianchi, Carlo Martinoli (2012) 'Shoulder', in Bianchi, Martinoli (ed.) Ultrasound of the Musculoskeletal system. India: Springer, pp. 190-330.
- Samira Saraya Rehab El Bakry Ultrasound ‘Can it replace MRI in the evaluation of the rotator cuff tears?’ (2016). The Egyptian Journal of Radiology and Nuclear Medicine 47, pp 193–201.
- Leroux JL, Thomas E, Bonnel F, Blotman F ‘Diagnostic value of clinical tests for shoulder impingement syndrome.’ (1995) Rev Rhum Engl Ed;62: pp 423–428.
- Iagnocco A, Coari G, Leone A, Valesini G ‘Sonographic study of painful shoulder’.(2003) .Clin Exp Rheumatol ; 21: 355–358. 16.
- Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Baños J et al. (2002), ‘Painful shoulder: comparison of physical examination and ultrasonographic findings.’ Ann Rheum Dis;pp 61: 132–136.
- Walton J1, Mahajan S, Paxinos A, Marshall J, Bryant C, Shnier R, Quinn R, Murrell GA. (2004) 'Diagnostic values of tests for acromioclavicular joint pain.',J Bone Joint Surg Am., Apr(86-A(4)), pp. 807-812.
- Stefano Bianchi, Carlo Martinoli (2012) 'Shoulder', in Bianchi, Martinoli (ed.)Ultrasound of the musculoskeletal system. India: Springer, pp. 232-234.
- RN Dorothy, J. Stuppy. (May 1998) 'The faces pain scale: Reliability and validity with mature adults', Applied Nursing Research, 11(2), pp. 84-89.